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
Rescheduling and Cancellation
At Valley Integrative Chiropractic, each appointment time is reserved just for you. Because we work closely with a limited number of patients and offer highly personalized care, your commitment to keeping appointments helps ensure you receive the best results and allows others the opportunity to be seen. Thank you for prioritizing this time as an important part of your health journey.
Key Points:
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48 business hours’ notice is required to cancel or reschedule without penalty.
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Late cancellations will incur a 50% fee; no-shows will be charged the full fee.
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New patients must pay a deposit (applied to the first visit), which is non-refundable with late cancellation.
Read our full Cancellation & Deposit Policy here
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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