New patients
Patient Forms
Complete your intake paperwork before your visit and we'll have you in the treatment room faster. All forms are available to download and print below.
No up-front care plans. No payments up front. Ever.
We treat on your first visit.
Download & print
New Patient Intake Forms
Print these forms, complete them at home, and bring them to your first appointment. If you'd prefer to fill them out at the office, arrive 15 minutes early.
New Patient Intake Form
Personal information, medical history, current symptoms, and insurance details. Required for all new patients.
HIPAA Privacy Notice & Acknowledgment
Our privacy practices and your rights regarding your health information. Required by federal law.
Auto Accident / PIP Intake Form
For patients injured in a motor vehicle accident. Includes accident details, insurance carrier information, and attorney contact if applicable.
Assignment of Benefits & Consent Form
Authorizes Riverside Chiropractic Co. to bill your insurance carrier directly and receive payment on your behalf. Required before treatment.
Forms are provided as PDF downloads. You'll need a PDF viewer such as Adobe Acrobat Reader to open them. If you have trouble downloading, call us and we'll mail or email them to you.
Questions about your visit?
Send Us a Message
Have a question before your first visit? Fill out the form below and we'll get back to you shortly. You can also call us directly at (941) 777-3690.
New patient special
New Patient Special — Only $50
Exam, consultation, and chiropractic adjustment — all on your first visit. No hidden fees. No pressure.
Call to Claim This OfferOffer for new patients only. Includes exam, consultation, and chiropractic adjustment. Not valid for Medicare, Medicaid, or other federal health-program beneficiaries. Cannot be combined with other offers.