(503) 344-4378 | Text us at 55678

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.
  • Fax us your printed and completed form(s) or bring them with you to your appointment.
  • The paperwork does not work on a cell phone!
  • Please enter each physical complaint individually, you will be asked "Do you have an additional condition?" at the end of each section. Call us with any questions or difficulties (503) 344-4378.

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
  • Medicare
  • Moda

We also offer a 15% time of service discount for patients paying with cash

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.

No Insurance?

REVIVE offers a 15% time of service discount to all patients who are not using insurance and paying out of pocket.


9:00am - 1:00pm
2:00pm - 6:00pm

9:00am - 1:00pm
2:00pm - 6:00pm

9:00am - 1:00pm
2:00pm - 6:00pm

9:00am - 1:00pm
2:00pm - 6:00pm

9:00am - 1:00pm
2:00pm - 6:00pm

9:00am - 2:00pm

Revive Injury and Wellness
1750 Blankenship Road Suite 295
West Linn, OR 97068
(503) 344-4378

“I have been coming here for about a year now and feel much better. The staff is very kind and professional. I highly recommend getting care here.”

« Philip P. »

“I recommend Revive because I can get immediate care without an appointment and relief quickly without unnecessary charges. AND THE STAFF IS AWESOME!!!”

« Theresa V. »

“The staff is amazing! They are caring and kind. A very professional group of people. The massage technicians are well trained to get to the core of the problem. I always feel so good after adjustments.”

« Shawn Z. »

Revive Injury and Wellness
1750 Blankenship Road Suite 295
West Linn, OR 97068
(503) 344-4378