New Patient Information

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

The New Patient Forms are not always compatible with Microsoft Edge/Internet Explorer. Please fill out the forms using a different browser. The New Patient Forms are best completed on a desktop or laptop computer. You may experience problems submitting the forms if completed on a tablet or smartphone.

Medicare Patients - We can NOT provide care for you in our office. Please click to learn more.

New Patient Forms

If you would like to come to our office as a new patient, please fill out the New Patient Forms. There is no need to call or inform our office, unless you have additional questions. The New Patient Forms take an estimated 10-15 minutes to complete, unless you have a detailed health history. Once your New Patient Forms have been completed and submitted to our office, we will call you to schedule your new patient appointment.

At Aligned Chiropractic, your first visit will begin with a warm smile and personal greeting! Please allow a total of two hours for your first in office visit.

If for some reason you will not be able to make your appointment, we request you provide at least 24 hours notice so that another person in need of the doctor's time may be helped.

New Patient Insurance

To see what insurances are considered in-network in our office click HERE.

If you have insurance you hope to utilize in our office:

Option 1: We will contact you after we receive your New Patient Forms. Completely fill out the Insurance Information section so that we may provide you with details on your insurance coverage in our office.

Option 2: Call our office to provide us with your insurance company name, ID number, date of birth, the subscriber name (and subscriber's date of birth if the subscriber is not you), and the phone number on the back of your card for provider services, or member services.

Option 3: Email us via the Request Appointment button to the right and type in your insurance company name, ID number, date of birth, the subscriber name (and subscriber's date of birth if the subscriber is not you), and the phone number on the back of your card for provider services, or member services. You can not attach images via the Request Appointment option.

New Patient Medicare

If you are 65 or older or have Medicare, please email our New Patient Coordinator at frontdesk@MySpinesAligned.com BEFORE filling out the online New Patient Forms.

We do not file with Medicare, or any secondary insurances affiliated with Medicare coverage. Due to Medicare laws regarding chiropractic care, we can NOT provide "medically necessary" care for you in our office. If you have opted out of Medicare, we MAY be able to provide medically necessary care for you. Please call our office.


HIPAA

Please read the Patient Privacy Act. Download & Read - Do Not Print
Signature forms are completed at the time of your New Patient appointment at Aligned Chiropractic.

If you do not already have AdobeReader® installed on your computer, Click to download.

Monday
2:30pm - 6:30pm


Tuesday
7:30am - 1:30pm


Wednesday
2:30pm - 6:00pm


Thursday
Closed


Friday
7:30am - 1:30pm


Saturday
Closed

Aligned Chiropractic
2004 Bremo Road Suite 101A
Richmond, VA 23226
(804) 477-3194