Online Paperwork

Below are new patient forms that can be filled out prior to your first appointment and brought with you to save time. There may also be additional forms that you will be given when you arrive at the office.

Insurance or Cash Patient History Form

This let’s us know what’s happened, but perhaps more important, where do you want to take your health?

 Download & Print Form

Pediatric History Form

Please fill out this form for children.

 Download & Print Form

Work Injury Form

If your health issue is the effect of an injury at work, this information will help us help you.

 Download & Print Form

Auto Collision Form

If your health issue is the result of a car accident, we need some additional information.

 Download & Print Form

Update Form

 Download & Print Form

Medicare Form

 Download & Print Form

Free AdobeReader®

Each form is a PDF document file.  If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.

Rainier Valley Chiropractic, 4236 36th Ave. So., Seattle, WA 98118 | (206) 723-2820