Life & Health Chiropractic Centre

Patient Intake Form

Welcome to our online Patient Intake Form. Via laptop, smart phone or tablet, the information you fill in will be sent directly to our office, speeding up your office visit and allowing us to better serve your healthcare needs. This form will ask for your main complaint and all of its details, before asking for any subsequent complaints. Please provide the name and phone number of your insurance, along with ID and group information. When your intake is complete, you will be able to sign the form. It will then be available for upload by our clinic.

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