Skip to content

New Patient On-Line Form

We are excited to help you achieve your Better Life so thank you for taking the time fill out our New Patient paperwork!

*When filling out paperwork for another person, such as your child, when it states “Please enter your name and email” please enter the PATIENT’S NAME. There will be a place in the form for the parent or guardian name.

**All patients need to arrive 5-10 minutes before their appointment time to complete registration.

***If your appointment involves a current CAR ACCIDENT or WORKERS COMPENSATION claim, please arrive 20 minutes early to complete registration.


Chiropractic adjusting image 

Adult Intake

Click Here

Chiropractic adjusting image 

Prenatal Intake Form

Click Here


Chiropractic adjusting image 

Pediatric Intake

Click Here

Chiropractic adjusting image 

Infant Specific Intake

Click Here


Better Life Family Chiropractic Forms | (509) 464-0444