Online Forms

Gilcher Chiropractic Life Center offers our patient form(s) online so they can be completed it in the convenience of your own home or office.

• If you do not already have AdobeReader® installed on your computer, Click Here to download.
• Download the necessary form(s), print, and then fill in the required information.
• Fax to us your printed and completed form(s) or bring it with you to your appointment.

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Laser Therapy Form

Download & Print Form

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New Patient Adult Health Form  

This lets us know your history and current state of health. Which questions, concerns, goals, regarding wellness can we help you with? Let us know!

Click Here to fill out the online form. 

Download & Print Form

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New Patient Child - Under 18 Health Form  

Click Here to fill out the online form.

Download & Print Form

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New Patient Adult Spanish Health Form

Click Here to fill out the online form.

Download & Print Form

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New Patient Child Spanish Health Form 

Click Here to fill out the online form.

Download & Print Form

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 Privacy Practices Notice 

Download & Print Form

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Patient Centered Medical Home (PCMH)

Download & Print Form

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Download the Free AdobeReader®

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