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608-782-7738
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Back-In-Action Chiropractic S.C. is now open in La Crosse, WI.  We are located downtown at 300 2nd Street N, Suite 220.

Back In Action Chiropractic 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.
  • Bring your completed forms with you to your appointment.

New Patient Information Form

Please bring photo identification and your insurance card (if applicable) to your appointment.  If you are a minor, please have a parent or guardian accompany you to your appointment.

Download & Print New Patient Forms (Required)

Download Optional Forms


HIPPA Forms

These forms are required by the Health Information Patient Protection Act.  If you have any questions as you read through these forms, please don't hesitate to ask.

Full Notice of Privacy Practices Download & Print Form (For your information)

Signature Page (included in New Patient Information above)


 Download the Free AdobeReader®

Featured Services

Services
We strive to provide high quality comprehensive care for our patients. Learn more about all the services we provide.
Make An Appointment
We will do our best to accommodate your busy schedule. Schedule an appointment today!
Online Forms
Our patient forms are available online so they can be completed in the convenience of your own home or office.