Intake Forms

blk-phone412-655-9300

5400 Keeport Drive, Pittsburgh, PA 15236

Patient Intake Forms

Welcome to Lifeforce Chiropractic Inc. in Pittsburgh! In this section you will find out how we can help you as a new patient. You can download Patient Intake Forms, take a tour of our office, use our My First Visit Interactive Tour, and learn more about your responsibilities as our patient. Please select a topic below that you would like to learn more about.

 

TO BE COMPLETED ONLINE:

CLICK ON THE URL BELOW TO COMPLETE THE ONLINE PATIENT INTAKE ASSESSMENT FORM.

https://www.mychirotouch.com/patientintake/?clientid=LCI0003





PRINTABLE PEDIATRIC INTAKE FORMS:

pdfNew Patient Newborn 2 Months

New_Patient_2_Months_to_2_Years.pdf

 shadow-2

You will need Adobe Reader to view and print this document.

If you do not have Adode Reader click the Icon below to download a free copy.

 

get acrobat reader


 

Additional Forms:

 
pdfNeck Pain Questionaire

pdfRoland Morris Questionnaire

pdfOwsestry Disability Index 

pdfAdrenal Fatigue Check 

pdfIodine Patch Test

pdfThyroid Temperature Test

pdfThyroid Questionaire

pdfHypothroid Check

pdfBasel Temperature Test

pdfGallbladder and Liver Flush

pdfSymptom Survey Form

pdfDiet Plan 

forms

Intake Forms

Save time by downloading our intake forms.
Read More...

payment-clouds

Payment Options

Our payment options are flexible and convenient.
Read More...

firstvisit

My First Visit

Find out what to expect at your first visit.
Read More...

photogallery

Photo Gallery

Photo gallery of Lifeforce Chiropractic.
Read More...

k-laser

Newsletter Signup

Get information about healthy living, Chiropractic and specials.
captcha

virtualtour

Virtual Tour

Take the YouTube Virtual Tour. 

Take Tour

3D Education

Interactive 3D Education.

Launch

Get Directions

Need help finding us?

Read More

Contact Us

412-655-9300

 

marker5400 Keeport Drive
Pittsburgh PA, 15236