Renaissance Chiropractic Center offers our patient form(s) online so they can be completed 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.
- Fax us your printed and completed form(s) or bring it with you to your appointment.
- Bring a form of ID and insurance card at first visit. Calling prior to your appointment to give us your insurance information and calling your insurance for benefits may aid information and benefits being available prior to or at your first appointment.
New Patient Form/Patient Update Forms- Patients may be asked to complete an updated intake form once per calendar year, upon a new incident or claim, or address and other info change. *Patients under the age of 18 MUST have a legal guardian's signature and contact information prior to being seen in office.
Download & Print New Patient Intake Form
Pediatric Intake Form (for children under the age of 12)
Automobile Accident Questionnaire- Please have your insurance information and/or the others involved in the accident with your paperwork.
Download & Print the Auto Accident Form
MASSAGE PATIENTS - Only coming in for Massage? Please print both forms below. EHR form must be completed on all new patients/clients and updated once per calendar year.
Download & Print New Massage patient form
General information: Pain in the neck? Low back? Try Passive Traction using Rolled Towels! *Talk to your doctor or massage therapist for more info.
Passive Traction using the towel rolls
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. 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 the Free AdobeReader®