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Online Forms for Chiropractic in Motion

Chiropractic in Motion offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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) or bring it with you to your appointment.

1)  New Patient Information

Download & Print Form


2)  HIPPA Form

Download & Print Form


3)  Chiropractic Intake Form

Download & Print Form


4)  Acupuncture/Homeopathy Intake Form

Download & Print Form



Download the Free AdobeReader®

Exclusive Offer

New patients offer $30 for your initial chiropractic exam and any necessary x-rays.

* Not valid with Medicare or Medicaid

Sign-up using the form or call us at 515-267-9956 to take advantage of this exclusive offer.

Office Hours

DayMorningAfternoon
Monday8:00 am6:00 pm
Tuesday8:00 am6:00 pm
Wednesday8:00 am - 11:00 amClosed
Thursday8:00 am6:00 pm
Friday8:00 am12:00 pm
SaturdayClosedClosed
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8:00 am 8:00 am 8:00 am - 11:00 am 8:00 am 8:00 am Closed Closed
6:00 pm 6:00 pm Closed 6:00 pm 12:00 pm Closed Closed