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.