New Patient Forms

Welcome to Life Chiropractic! We know your time is precious so we’ve made our patient intake forms available on this page.

  • New Patient Forms (to be completed online). For patients under 10 years of age, please answer “Yes” to the question “Is this concern associated with a child developmental concern or condition?” to prompt the Pediatric Evaluation section to appear.

If you have any difficulty completing the forms please call (805) 737-5656 for assistance.

Preferred Provider for Blue Shield and Blue Cross
Active-Duty Military Discount


Call Now Button