Patient Forms

Renaissance Chiropractic Center 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.
  • Bring completed forms with you to your appointment.
  • Bring a form of ID and insurance card* at first visit.

*If using insurance or have a question about your insurance benefits, eligibility, how much out of pocket for your visits may be or if we accept your insurance, please call prior to your appointment with your insurance information. Information given to us from insurance companies are only quotes and the benefit information may change at any time. We do the best we can to give the most accurate and up to date insurance information and contact you to let you know your out of pocket cost.

New Patient Form/Patient Update Forms- Patients may be asked to complete an updated intake form once per calendar year, upon a new incident or claim, or address and other info change. Click on forms needed to print below.

*Patients under the age of 18 MUST have a legal guardian's signature and contact information prior to being seen in office.

Download & Print New Patient Intake Form

Parent or guardian must sign forms prior to minor being seen in our office. Pediatric Intake Form (for children under the age of 12)

Download & Print Pediatric Form

Were you involved in an Automobile Accident? Print forms below and bring in to your first appointment. Please have your insurance information and/or the others involved in the accident with your paperwork.

Download & Print the Intake Form for Auto Accidents Form

Download & Print  the Auto Accident Form

MASSAGE PATIENTS - Only coming in for Massage or need a referral from your doctor? Have your doctor fax the referral to 253-473-0305 prior to your first appointment. Referral must be on file prior to scheduling. Please print both forms below, complete and bring your first appointment along with Photo ID and your insurance card.

Download & Print Massage Intake Form 

**Appointments cancelled with less than 24 hours notice will be charged a $40 missed fee.

Has it been awhile since you've been in? 6 months? 1 year or more? Don't forget to print your paperwork and bring in your updated insurance information! Moved? New phone number? Let us know when you come in to help us keep our records accurate and up to date!

General information: Pain in the neck? Low back? Try Passive Traction using Rolled Towels! *Talk to your doctor or massage therapist for more info.

Passive Traction using the towel rolls

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Contact Us

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Our Location

4902 Tacoma Mall Blvd. Tacoma, WA 98409

Office Hours

Find Out When We Are Open



9:00am - 12:30pm

2:00pm - 6:00pm


9:00am - 1:00 pm

3:00pm - 7:00pm


9:00am - 12:30pm

2:00pm - 6:00pm


9:00am - 1:00 pm

3:00pm - 7:00pm


9:00am - 12:30pm

2:00pm - 6:00pm


9:00am - 12:00pm