Online Forms

DO YOU WANT TO SAVE 20 MINUTES ON YOUR FIRST APPOINTMENT?

Lifeline Chiropractic offers our patient form(s) online so you can complete them 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 forms, print it out and fill in the required information.
• Bring in your completed forms or fax it to our office: (714) 662-7957.

New Patient Health History Form - Required

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

Download & Print Form

Terms of Acceptance Form - Required

This form explains that we are Chiropractors and that we Adjust Vertebral Subluxations (Spinal Misalignments).  This Acceptance Form is Required.  Thank you.

Download & Print Form

Office Policy Form - Required

Standard Office Policy Information.  Also Required.

Download & Print Form

Child Information & Release form - Optional

This let’s us know the history and current state of your child's health.  If this appointment is for a minor child, this form is required.

Download & Print Form

Auto Accident Form - Optional

If you were involved in a Motor Vehicle Accident then this form is required.

Download & Print Form

Work Injury Report Form - Optional

If you were injured on the job then this form is required.

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!