BACK IN ACTION
CHIROPRACTIC, ACUPUNCTURE AND MASSAGE THERAPY
RICHMOND,VA
Back In Action offers our patient form(s) online so you can complete it in the convenience of your own home or office.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary form(s), print it out and fill in the required information. Please note there are 2 pages.
- Fax us your printed and completed form(s) or bring it with you to your appointment.
- If you choose to download the form where you type your answers, you will still need to print it in order to draw on the pain diagrams, and to sign the form.
CLICK HERE TO DOWNLOAD THE NEW PATIENT HEALTH HISTORY FORM THAT HAS BEEN MODIFIED SO THAT YOU CAN DOWNLOAD IT TO YOUR COMPUTER AND TYPE IN YOUR RESPONSES.You can download and print this form and write in your answers, as well. It is just that the option exists to type your answers. You will still need to print it, in order to draw on the pain diagrams and to sign the form. There are 2 pages.
Here are other downloadable form options for the chiropractic and acupuncture new patient forms, in the event that the above form does not download properly:
DOWNLOAD NEW PATIENT INTAKE FORM - PAGE 1
DOWNLOAD NEW PATIENT INTAKE FORM - PAGE 2