Online Forms

Active Life Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the necessary form(s), print it out and fill in the required information.
• Fax us your printed and completed form(s) or bring it with you to your appointment.

Please note that due to the potential longer time of your first visit a $25 charge will required to be payed by the patient if a new patient appointment is cancelled without 24 hours notice

NP Health History and Insurance Authorization - Required

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Complete Online and Submit (Prior to your first visit)

Outcome Assesment Forms : Please choose back or neck or both, depending on your location of discomfort.

Bournemouth Neck

Download & Print Form

Bournemouth Back

Download & Print Form

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!