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                                                                                                        BACK IN ACTION 

 CHIROPRACTIC, ACUPUNCTURE AND MASSAGE THERAPY

RICHMOND,VA

Back In Action offers our new patient form(s) online so you can complete it in the convenience of your own home or office. It is accessible by a computer desktop, laptop, tablet or cell phone. 

  • The secure online new patient forms take 5-15 minutes to complete, depending on your health history.
  • Please be sure to complete the insurance information section if you will be using your insurance in our office.
  • As a courtesy, we will verify your policy's Chiropractic benefits prior to your visit.
  • No need to print! Just complete and submit!

 

New Patient Electronic Forms




If you do not have access to a cell phone or internet connected device and need to complete the New Patient Form in our office, please arrive 30 minutes prior to your appointment. We will provide a laptop for your convenience to complete the form.



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Testimonial

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