New Patient Paperwork

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

Chiropractic Intake Form

The following form(s) are to be done in addition to the standard patient intake.

Child (1-13 Years)

Infant (1-12 Months)

  • The forms below are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer,
    Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Bring the necessary form(s) to your appointment.

Massage Intake Form

Acupuncture Intake Form

HIPAA Privacy Notice

OFFICE HOURS


Monday
8:00am - 7:00pm


Tuesday
8:00am - 6:00pm


Wednesday
8:00am - 7:00pm


Thursday
Closed


Friday
8:00am - 5:00pm


Saturday
Closed

LiveWell Chiropractic
& Wellness Center

3456 Holiday Court Suite A
Bettendorf, IA 52722
Phone: (563) 332-7110
Fax: (563) 332-7234