New Patient Paperwork

Your first visit to Sheldon Road Chiropractic & Massage Therapy establishes the vital foundation for successfully treating your condition or injury.. During the first visit, we make sure to obtain information about your physical complaint, medical history, and give you time to get to know your doctor. To understand what to expect from your first visit to our practice, please read through this page. You'll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more. There's background information about our first visit procedures. You can even save some time at your first visit by either filling out your information online via electronic submission OR printing out and completing the new patient forms in advance of your appointment .

Mission Statement

Our Doctors and staff strive to treat our patients with the same skill, care and compassion that we treat members of our own family.


Patient Forms

(download and print forms)

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.

Please fill out the correct paperwork according to the type of patient account you wish to have with our office:

  • Time of Service Patient (cash):

New Patient Form, Health History Form, HIPPA, Electronic Health Record, Statement of Financial Responsibility

  • Insurance Patient:

New Patient Form, Health History Form, Assignment of Benefits, HIPPA, Electronic Health Record, Statement of Financial Responsibility

To determine insurance coverages please call us at 813-884-1457 our staff will obtain the necessary information, call your insurance carrier and obtain coverages, co-pay information, deductibles and any other relevant information.

  • Personal Injury Patient:

New Patient Form, Health History Form, Assignment of Benefits, Auto Accident Questionnaire, HIPPA, Electronic Health Record, Statement of Financial Responsibility

  • Worker's Compensation Patient:

New Patient Form, Health History Form, Assignment of Benefits, Worker's Compensation, HIPPA, Electronic Health Record, Statement of Financial Responsibility

You need to install Acrobat Reader if you don't see the image. Please turn off any POP-UP BLOCKER before opening these forms. Please click HERE to install the Acrobat Reader.

What to expect

Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. Also, take some time to review our staff page and familiarize yourself with the doctors. We look forward to your first visit.

For patients who have undergone X-rays, MRIs (in the ast 12 months) or other diagnostic studies please bring any reports or films in your possession, this will save time and potentially save you money.

Contact Us

Hours of Operation

Our Regular Schedule

Monday

9:00 am - 1:00 pm

2:00 pm - 6:00 pm

Tuesday

9:00 am - 1:00 pm

2:00 pm - 6:00 pm

Wednesday

9:00 am - 1:00 pm

2:00 pm - 6:00 pm

Thursday

9:00 am - 1:00 pm

2:00 pm - 6:00 pm

Friday

9:00 am - 1:00 pm

2:00 pm - 6:00 pm

Saturday

9:00 am - 1:00 pm

Sunday

Closed

Monday
9:00 am - 1:00 pm 2:00 pm - 6:00 pm
Tuesday
9:00 am - 1:00 pm 2:00 pm - 6:00 pm
Wednesday
9:00 am - 1:00 pm 2:00 pm - 6:00 pm
Thursday
9:00 am - 1:00 pm 2:00 pm - 6:00 pm
Friday
9:00 am - 1:00 pm 2:00 pm - 6:00 pm
Saturday
9:00 am - 1:00 pm
Sunday
Closed