New Patient Paperwork

Your first visit will begin with some simple paperwork helping us to get to know you better. After a short period you will be taken back into the back office for a brief tour of our facility and finally escorted into our exam room. It is there where the doctor will perform an extensive consultation with you to determine more about the cause of your problem. Following the consultation the doctor will perform an extremely thorough neurological and physical examination to further diagnose the cause of your problem. After this if the doctor feels an x-ray of the area is needed, an evaluation will be performed at that time. We perform no testing prior to explaining why we need each test. You are always in control and educated about our process and treatment protocols. Generally after all testing is completed you will be released for the day so that the doctor may review your exam and x-ray findings. You will receive a scheduled visit to review your x-ray and exam findings before leaving. Most new patients will receive treatment following their report of findings, if the doctor feels chiropractic can help. If the doctor doesn’t feel treatment is recommended he or she will make the proper referral to the appropriate specialist. As always, we are here to give you and your family the best service possible!

Revive and Restore Chiropractic 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.


8:00am - 12:00pm
2:00pm - 6:00pm

2:00pm - 7:00pm

8:00am - 12:00pm
2:00pm - 6:00pm

8:00am - 12:00pm
2:00pm - 6:00pm



Revive and Restore Chiropractic
399 West Maple Leaf Road
Suite B
Maysville, KY 41056
(606) 564-9900