New Patient Forms
The best way to complete your intake forms is online through the portal. You will receive a link in your email. However, if you are unable to access those, choose the forms below based on which appointment(s) you have scheduled.
These need to be completed and returned to the office at least 24 hours prior to your appointment time so Dr. Becca has time to review them before your appointment.
You may email the completed forms to DrRoush@valleyintegrativechiro.com
New Patient Structure Adjustment
Choose this form if you are booking a chiropractic adjustment of any technique for an ADULT patient:
Financial & Communication Policy
Credit Card Storage Authorization
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For MINOR patients, please use the following set of forms:
Financial & Communication Minors
Consent to Use AI Notes Minors
Credit Card Storage Authorization
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New Patient Nutrition Adjustment
Choose this set of forms if you are booking a nutrition adjustment for an ADULT patient:
Intake Form Nutrition Addendum
Financial & Communication Policy
Credit Card Storage Authorization
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For MINOR patients, please use the following set of forms:
Financial & Communication Minors
New Patient
Neuro-Emotional Adjustment
Choose this form if you are booking a neuro-emotional adjustment for an ADULT patient:
Financial & Communication Policy
Credit Card Storage Authorization
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For MINOR patients, please use the following set of forms:
Intake Form Neuro-Emotion Minors
Financial & Communication Minors
Consent to Release Records
Consent to Release Records
This form is used to release your records from Valley Integrative Chiropractic to another provider:
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