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Life: New Patient Intake Forms

Life Chiropractic offers our patient form(s) online so they can be completed 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 it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

Life Chiropractic New Patient Intake Forms                     
             Dr. Reggie S. Fuller, D.C.                                                     

               Download & Print Form                                                                  




 


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Office Hours

Our Regular Schedule

Monday:

7:00 am

6:00 pm

Tuesday:

8:00 am

6:00 pm

Wednesday:

7:00 am

6:00 pm

Thursday:

7:00 am

6:00 pm

Friday:

9:00 am

4:00 pm

Saturday:

9:00 am

12:00 pm

Sunday:

Closed

Testimonial

Reviews By Our Satisfied Patients

  • "When I first met Dr. Nick, my two month old son Parker was constipated and unable to turn his head to the right due to Torticollis. I am happy with how quickly Parker has responded to his treatments. After only a few adjustments, Parker is no longer constipated and can move his neck freely. I am amazed by his movement! I strongly recommend infant chiropractic care to all parents!"
    Maddy Eden Prairie, MN