New Patient Paperwork

Revive Injury and Wellness offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer,
    Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Bring the necessary form(s) to your appointment.
  • New Patient Intake Form - Online

    Click to Complete

  • New Patient Intake Form

    Click to Download

  • Verify Your Insurance

    Click to Download

We Work With Most Insurance Groups

At Revive Injury and Wellness, we accept most forms of insurance. Our practice is IN NETWORK with the following:

  • American Specialty Health
  • First Choice (going out of business soon)
  • Kaiser
  • Complimentary Health Plans
  • Providence
  • Health Net
  • Pacific Source
  • Regence Blue Cross Blue Shield
  • United
  • Aetna
  • Cigna
  • Lifewise
  • UMR
  • Moda

Some plans may have a different name but run through one of the panels we are on. If you are uncertain, please call our office and we will gladly check insurance benefits on your behalf. When calling, please be prepared with your group number, identification number and date of birth. To learn more about our payment options for chiropractic and wellness care, you can call our West Linn chiropractic office directly and one of our friendly staff will be happy to answer all your questions.

On the job injury?

No problem, we will gladly bill Workman’s Compensation on your behalf.

Involved in an auto accident?

Don’t worry, we will bill your auto insurance. In the state of Oregon, it is required by law to offer $15,000.00 of medical coverage or Personal Injury Protection (PIP) as long as you have auto insurance.


9:00am - 1:00pm
2:00pm - 5:00pm

9:00am - 1:00pm
2:00pm - 5:00pm

9:00am - 1:00pm
2:00pm - 5:00pm

9:00am - 1:00pm
2:00pm - 5:00pm

9:00am - 1:00pm
2:00pm - 5:00pm

Saturday & Sunday

Revive Injury and Wellness

1750 Blankenship Road #295
West Linn, OR 97068

(503) 344-4378