Victoria East Chiropractic Clinic

New Patient Forms

If you are new to our clinic please follow the link on our Online Booking page and create an account - you are then able to complete the forms online as we are now using electronic charts.  If you prefer you are also able to download, print and complete the applicable “New Patient Intake” forms listed below. Our office staff will collect the forms from you upon your arrival. Alternatively, you may visit our online booking page and complete the paperwork online. If you have any questions, please call our clinic at 306-525-6977.

Chiropractic Intake Form
Massage Intake Form


We direct bill chiropractic and massage treatments to insurance companies as a courtesy, only if the plan allows the payment to be made electronically to the servicing provider.  At this time we are able to bill to the following - Saskatchewan Blue Cross, Manulife, Chamber of Commerce, Sun Life and Great West Life.  Please note - this is Your benefit plan, therefore it is your responsibility to confirm the plan coverage allowances (per visit/per year) and if the plan can pay the service provider. We need that information prior to putting a claim through. Please print the following forms, complete them and bring them with you to your next appointment.   We ask that you notify the front desk upon arrival so that we can complete the billing process. We are unable to bill acupuncture, or secondary coverage.