Lifecare Chiropractic
1830 S. Alma School Rd
Bldg 7, Ste 135
Mesa, AZ 85210
(480) 839-2273

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New Patient Forms

For your convenience, we offer the new patient intake forms in 2 formats

We offer an Interactive New Patient Form. Please complete the highlighted regions with your computer, then, print out the form.  Some areas are not inputable so please review the forms after you have printed them. Then, sign the form and bring it with you to your first visit.

Interactive New Patient Form

For Internet users with slower Internet connections, the Quick Download New Patient Form link will provide you with the patient intake form. Please print out the form, fill in with your information, sign the form and bring it with you to your first visit.

Quick Download New Patient Form

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