New Patient Information

New Patient Forms

All new patients will need a new patient exam to continue care. Please complete the new patient paperwork, by printing the documents below. If you do not have access to a printer to complete the necessary forms, you can complete them in our office. *If the appointment is for a minor, please also print and have the Consent to Treat a Minor paperwork filled out as well*

Arrive 15 minutes before your scheduled appointment to complete. 

Patient Intake Form.pdf
consent to treat minor.pdf
Cancellation notice new pt paperwork

Insurances Accepted

You can also contact our Billing Manager at for questions and concerns.

Appointment Policies

We want to be sure that all Cleasby Chiropractic patients can be seen in a timely manner. So, if you need to cancel/reschedule your appointment, please CALL the office.  

Last appointment of the day is scheduled 15 minutes before close.

For new patient appointments, arrive 15 minutes prior to your appointment to complete the necessary paperwork. 

For massages: In instances of No call/No show, you will be charged a $30 fee. 

For adjustments Beginning April 1st 2023 No call/No show, you will be charged a $30 fee.