New Patient Paperwork

So that we may make your initial visit as quick as possible, please complete the following form in full prior to your first visit. If you have any recent imaging reports please bring them with you to your visit as well. We ask that new patients arrive 10 minutes early to their appointment. Please contact the office at (904) 338-9995 if you have any questions.

Download New Patient Paperwork in PDF Format Download New HIPPA Privacy Practices in PDF Format

Due to the nature of chiropractic and soft-tissue therapies, for your comfort, we ask that patients bring or wear athletic shorts and that women also bring or wear a tank top or sports bra.


Most health insurance plans offer chiropractic coverage both in and out of network, a referral is not normally necessary. We will check your insurance benefits for you and file electronically on your behalf.

We currently participate in-network with the following health insurances:

  • Aetna
  • Blue Cross Blue Shield
  • Humana
  • United Healthcare
  • Other smaller health insurance companies that may be associated with the plans above (please call the office at (904) 338-9995 so we may check your benefits)

Injuries resulting from auto accidents and work injuries are typically covered by your auto insurance and workers compensation policies respectively. We also accept and offer CareCredit to our patients to help manage the cost of treatment. Please ask us for more information if you are interested.