New Patient Paperwork

Salt & Light Chiropractic offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • Click on the link below to bring you to the online intake form.
  • Please read the first page and then click "Next" to bring you to the form.
  • Carefully fill out all the information as best you can.
  • Please read the waver at the end, click "Agree" and electronically sign the form.
  • After you have filled it out and submitted it, if you remember something else to add or that you missed, please write it down and bring it to your appointment. We can update the information then.

10:00am - 12:00pm
2:30pm - 6:00pm

2:30pm - 6:00pm

10:00am - 12:00pm
2:30pm - 6:00pm

2:30pm - 6:00pm

10:00am - 12:00pm
2:30pm - 6:00pm

Saturday & Sunday

Salt & Light Chiropractic
6225 Brandon Avenue Suite 175
Springfield, VA 22150
Call: (703) 775-0004
Text: (703) 278-3877