New Patient 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 or email us your printed and completed form(s) or bring it with you to your appointment.

New Patient Health History

These forms lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

New Patient Health History Form (for all new patients age 18 and over)

Teen Health History Form (for all new patients age 10-17)

Pediatric Health History Form (for all new patients under 10 years old)

New Massage Patient History form

This form is for anyone who has never received a massage in our office and wants to. You do not have to be a chiropractic patient to receive a massage. The purpose of this form is to learn about your massage needs.

New Massage Patient History Form


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