Office (703) 385-7007

Patriot Chiropractic Center   

Dr. Steven Bernabeu & Dr. Gina Simonetti

New Patients:

To get the most out of your time with the doctor during your initial appointment, it is best if you fill out your paper work ahead of time. The  new patient paperwork can be found on the right of this page. Otherwise, it is best if you arrive 15 minutes before your scheduled appointment  time to complete the required forms.

New Patient Forms:

- Patient Registration  (download)
- Patient Case History (download)
- Consent to Treatment of a Minor    (download)
- HIPPA Notice of Privacy Practices  (download) 
- Office Policy (download)

Existing Patient Forms:

- Medical Records Release    (download)

- Update Contact Information (download)


Nutritional Forms:

- Nutritional Assessment (download)