Welcome New Patients!
Dear New Patient,
We at Healthy Life Chiropractic would like to take this time to welcome you to the office and congratulate you on deciding to better your health! We are excited to invite you to be a new patient at our practice! We believe that chiropractic care is an essential part of natural wellness and are happy to help facilitate this need.
We hope that you realize the importance of filling out the paperwork. The information given on these forms enables us to tailor your care to best suit your needs. The doctor must know everything about your past history in order to address your condition correctly. It is very important to list all accidents from birth to present time. Please read over the paper work and fill it out in great detail. Please make sure not to leave any questions unanswered and, even if it does not apply to you, please just mark those with "n/a" so that we are aware that you did see and read the question. Remember, we are always here to answer any questions you may have!
We welcome you to the wonderful and rewarding world of chiropractic and hope that we will fill all of your chiropractic needs.
Thank you for choosing Healthy Life Chiropractic!
New Patient Forms:
The following forms are required for new patient appointments. Please be sure to arrive 15 minutes early for your appointment with the required forms already completed.
Please note: if you do not have your paperwork filled out completely and/or do not arrive to your appointment on time, we may have to reschedule your appointment.
If you have any questions about these forms, please do not hesitate to call!
Chiropractic New Patient Forms
Infant-7 years old:
8 years old - 15 years old:
16 years old - Adult:
(More paperwork may be required depending on your insurance)
1st Time Reflexology:
Reflexology Intake Form
1st Time Ionic Foot Bath:
Ionic Foot Bath Intake Form