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

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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