Active Life Chiropractic

37 1/2 Forrester Street

Newburyport, MA 01950 US

978-463-8881

978-463-4411

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.

In order to limit time spent in office, the history taking portion of your exam will take place via phone in advance of your appointment. The doctor will call to speak with you the day before or the same day as your appointment.

We kindly ask that you arrive 10 minutes prior to your scheduled appointment time. There will be a few additional forms for you to fill out.  Our waiting room is in compliance with social distancing recommendations and masks are mandatory at all times. 

NP Health History and Insurance Authorization - Required

This helps us to gather your demographic and health history information prior to your visit in order to save spent time in office.

Complete Online and Submit (Prior to your first visit)

If your appointment is due to neck or back pain, please fill out and bring in the applicable outcome assessment form below:

Bournemouth Neck

Download & Print Form

Bournemouth Back

Download & Print Form

Functional Rating Index

Download & Print Form



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CONTACT US TODAY

We look forward to hearing from you

Locations

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Office Hours

Our Regular Schedule

Monday:

1:00 pm-5:00 pm

Tuesday:

8:30 am-4:00 pm

Wednesday:

2:00 pm-5:00 pm

Thursday:

8:30 am-4:00 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed