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!
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.
Office Policy Form - Required
Standard Office Policy Information. Also Required.
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.
Auto Accident Form - Optional
If you were involved in a Motor Vehicle Accident then this form is required.
Work Injury Report Form - Optional
If you were injured on the job then this form is required.
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