New Patients

On this page you will find common information about becoming a new patient, including links to the new patient forms.

We are always accepting new patients, & same-day appointments are available.

Call (319)-393-4303 to schedule an appointment. If you are a new chiropractic patient, you may complete the forms below prior to coming in. Paper forms are available as well from the front desk. All new patients will need to sign the HIPPA and Consent forms prior to being seen.

For SoftWave Therapy please call (319)-393-4303 to schedule your first appointment.

We look forward to welcoming you to our chiropractic office in Cedar Rapids.

New Patient Forms

If you are new to the office complete the new patient forms found on this page. You can also download, print, and fill them out and bring them to your first appointment. This will save you 15-20 minutes in the office. If you are unable to print the forms, we also have them available at the front desk. If the appointment is for a child (2 and under), please fill out the forms labeled “Pediatric Intake Paperwork". Please fill out the forms completely and as accurately as possible.

If this is for a work injury or auto accident, please also fill out the additional accident form as well. You may also scan the filled-out paperwork and email them back to us ahead of time at jenkinschiropracticandwellness@gmail.com.

Adult Paperwork (Ages 3 & Up)

New Patient Paperwork 2023 (Must be completed on a computer, NOT a phone.)

Pediatric Paperwork (Ages 0-2)

Pediatric Intake Forms (Must be completed on a desktop, not a cellular device.)

Auto Accident or Work Injury Paperwork

If you have been involved in a car accident or work injury, please bring in the additional form listed below, as well as the normal adult paperwork listed above. If you have been involved in an auto accident, please bring your car insurance ID card as well.

Accident Questionnaire

Insurance Information

We currently accept all major insurance plans that will allow us to be in network with them. This includes Blue Cross Blue Shield, United Health Care, Medicaid, Medicare, Molina, Amerigroup, Iowa Total Care, Cigna, Aflac, Preferred One, UMR, and many other small companies. We do not accept Coventry.

Appointment Request

Please fill out this form and we will contact you about scheduling. Questions? Call (319) 393-4303

What Our Patients Say

Your Health, Our Priority

Featured Services

Helpful Links