Welcome to Active Living Chiropractic! Thank you for choosing our office to restore your health, improve function and maximize performance!

Please fill out the necessary forms below before arriving for your appointment.  Please take the time to fill them out completely and to the best of your ability, as this information is needed to provide you with the most appropriate and effective care.

Insurance and Payment Information

We are contracted providers for many insurance plans; please call your insurance company to verify your benefits prior to coming in.  Please be aware that copays are due at the time of service.  If you have a high deductible plan, we recommend paying $50 each visit.

Payment methods accepted are: Visa, MasterCard, Discover, Cash, Personal Check

REMEMBER…

Please make sure to bring the following with you for your first appointment:

• Insurance Card and driver’s license if possible.
• Copies of any previous diagnostic studies or reports such as, X-rays, MRI’s, EMG/NCV reports.

New Patient Forms

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