If you need a more accessible version of this website, click this button on the right. Switch to Accessible Site

WARNING

You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]

Social Contacts

 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.

Click here to download the new patient forms for Susan Sandlin, acupuncturist.

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


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form



Download the Free AdobeReader®