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