New Patient Paperwork
Super Simple + Done Before You Arrive
We value your time. That’s why all new patient paperwork at Revival Health Center is 100% digital and can be completed from the comfort of your home…or phone.
Most patients finish their forms in 5–10 minutes, helping you feel at ease for an efficient and stress-free first visit.
Adult Paperwork - Ages 18+
For adults receiving chiropractic care:
Helps us understand your health goals before your visit
Takes about 5-10 minutes
Pediatric Paperwork - Ages 3 to 17
For children and teens receiving care:
Filled out by a parent or legal guardian
Helps us understand your child’s health history + the current state of their nervous system
Takes about 5–10 minutes
Infant Paperwork - Ages 0 to 2
For infants receiving chiropractic care:
Filled out by a parent or legal guardian
Helps us understand your child’s health history + the current state of their nervous system
Takes about 5–10 minutes
Why We Ask You to Complete Paperwork Ahead of Time
Completing your forms before your visit allows us to:
Respect your time and minimize waiting
Fully understand your health history and concerns
Focus on care and connection
Create a personalized, nervous system–based care plan
Need Help or Have Questions?
If you have trouble accessing the forms or aren’t sure which paperwork to complete, we’re happy to help.
Call or Text us at 515-895-1400
Revival Health Center – Clive, IA
We can’t wait to welcome you and your family.