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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  

 


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Locations

Find us on the map

Office Hours

Our Regular Schedule

Monday:

9am - 11:30am

2:45pm - 6pm

Tuesday:

Dr. S - 9am - 11:30am

Closed

Wednesday:

9am - 11:30am

2:45pm - 6pm

Thursday:

9am - 11:30am

2:45pm - 6pm

Friday:

Dr. D - 9 - 12

Closed

Saturday:

Appt Only

Closed

Sunday:

Closed

Closed

Testimonials

Reviews By Our Satisfied Patients

  • "I used to have such terrible back pain that I would just go straight to bed when I got home after work. Now I have much fewer days like that. I commute a lot and this treatment has helped my driving become much less of a painful process. Give it a try! It is worth it."
    Dani G., Whittier, CA
  • "Dr. Daily is the best! I would never trust someone else with my health or more importantly my family's health... Thank you for many great years!"
    Laurie M. Fountain Valley, CA