If you need a more accessible version of this website, click this button on the right. Switch to Accessible Site

WARNING

You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]

Call Us Today

509-783-2225
m


BACK TO BASICS CHIROPRACTIC

8033 W Grandridge Blvd Ste C
Kennewick, WA 99336
509-783-2225

Online Patient Registration

Welcome to our Online Patient Registration site. To better serve your healthcare needs and speed up your office visit, please take a moment to complete the content within this online form. The information you fill in will be sent directly to our office when you click the Submit Registration button at the bottom of this page.

For security purposes, navigating away from this page before clicking the Submit Registration button will erase all content within the form. Successful submission will redirect you to a confirmation page.

Personal Information

Contact Information

Emergency Contact

Employment Information

Primary Insurance

Guarantor

Appointment Information

:

Featured Services

Services
We strive to provide complete care for our patients. Learn more about all the services we provide.
Request Appointment
We will do our best to accommodate your busy schedule. Schedule an appointment today!