Online Forms

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.
  • Bring completed forms 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. *Information given to us from insurance companies are only quotes. The benefit information may change at any time. We do the best we can to give the most accurate and update information. Payment for visit will be 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

Parent or guardian must sign forms prior to minor being seen in our office. Pediatric Intake Form (for children under the age of 12)

Download & Print Pediatric Form

Were you involved in an Automobile Accident? Print forms below and bring in to your first appointment. Please have your insurance information and/or the others involved in the accident with your paperwork.

Download & Print the Intake Form for Auto Accidents Form

Download & Print  the Auto Accident Form

MASSAGE PATIENTS - Only coming in for Massage or need a referral from your doctor? Have your doctor fax the referral to 253-473-0305 prior to your first appointment. Referral must be on file prior to scheduling. Please print both forms below, complete and bring your first appointment along with Photo ID and your insurance card. 

Download & Print New Massage patient form

Has it been awhile since you've been in? 6 months? 1 year or more? Don't forget to print your paperwork and bring in your updated insurance information! Moved? New phone number? Let us know when you come in to help us keep our records accurate and up to date!

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

Download the Free AdobeReader®

CONTACT US TODAY 253-473-0300

We look forward to hearing from you. Please have your insurance information ready when you call.


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