Draft — pending review. This page is a plain-language draft and is being reviewed before it becomes our final policy.
We only ask for what we need to care for you and to get back to you. Here’s what our website forms collect, where it goes, and how to reach us with questions.
New-patient form (/new-patient-intake/): your name, date of birth, mobile number, email (optional), address, how you heard about us, what you’d like to be seen for and for how long, any prior chiropractic care, whether it’s related to an accident or injury, and your insurance or self-pay details. We also ask for a photo of your government ID, and of your insurance card if you’re using insurance.
Book, move, or cancel (/schedule/): your name, phone number, the last two digits of your birth year (so we can confirm it’s really you), what you’d like to do, the day and time you pick, and an optional note.
In-office check-in tablet: your phone number and your answers about how you’re feeling today, including the pain diagram. These go into your chart in our patient records system.
When you book or change a visit with a live open time, you’ll get an automatic text confirmation. Texts come from our records system. Msg & data rates may apply; reply STOP to opt out. Our office phone doesn’t send texts, so anything else is confirmed by a phone call.
Your mobile number and text consent stay with us. Mobile numbers and SMS opt-in consent are never shared, sold, or rented to third parties or affiliates for marketing or promotional purposes. Information about texting is used only to send you the messages you asked for. Reply STOP to any text to opt out, or HELP for help, or call us at (941) 220-6993. See our Text Messaging Terms.
Our website host records basic, anonymous visit statistics, such as which pages are viewed. We don’t run ads on this site.
Information that becomes part of your care is kept with your chart in our records system. To request a copy of your medical records, we’ll ask you to sign a medical records release form — call us at (941) 220-6993. You can also call with any question about what we have on file, or to ask us to correct it.
Our forms aren’t watched around the clock. If you have a medical emergency, call 911. For anything urgent about your care, call us at (941) 220-6993 during office hours (Mon–Thu 9–6, closed 12–1 for lunch). The information on this website is general and isn’t medical advice — Dr. Moore evaluates you in person before recommending care.
Call (941) 220-6993 or stop by: Two Palms Chiropractic & Wellness, 5620 Tara Blvd, Suite 103, Bradenton, FL 34203.
Last updated October 20, 2026 (draft).