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Atlantic Chiropractic and Rehabilitation offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) to 757-547-2027 or bring it with you to your appointment.

New Patient Forms- Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download Print and Complete Patient History Form

Download & Complete EHR Intake Form

Download, Print & Complete Patient Consent

Download, Print, & Complete Patient Intake

Please choose the form(s) below that best describes your chief complaint(s)

Download & Print Low Back Pain Form

Download & Print Knee Form

Download & Print Neck Form

Download & Print Shoulder Form

Download & Print Upper Extremity Form

Download & Print Hip Pain Oswestry

If you were involved in an accident and need Personal Injury Forms, Please print the following:

Personal Injury Forms

Download Print and Complete Patient History Form

Assignments of Benefits Form

EHR Form


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form


New Patient Massage Forms - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form


Download the Free AdobeReader®