Virginia Institute of Chiropractic  
1424 Greenbrier Place  
Charlottesville, VA 22901  
Telephone: 434.872.9440  
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Patient Forms
New patients please use the online form OR download, print, and fill out the initial patient paperwork forms. We would also like you to visit www.uppercervicalcare.comand watch the first two videos under the Learn tab. These videos do a wonderful job of explaining what we do. For directions to the office, please click on the Contact Info link above.

Online form for new patients to be completed before first visit, including Terms of Acceptance page and Financial Agreements page. Click here to use the form.

New Patient Intake Form (to print and bring to first visit)
New patient paperwork to be completed upon first visit (or do it online above), including Terms of Acceptance page and Financial Agreements page. Download pdf file here.

Online form for to be completed before your first massage. Click here to use the form.

Massage Therapy Intake Form (to print and bring to office)
Download and complete before your first massage. Download pdf file here.
 
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