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

    Click to Complete

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

  • Child (1-13 Years)

    Click to Complete

  • Infant (1-12 Months)

    Click to Complete

  • 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.

  • Acupuncture Intake Form

    Click to Download

  • HIPAA Privacy Notice

    Click to Download

OFFICE HOURS

Monday
8:00am - 7:00pm

Tuesday
8:00am - 7:00pm

Wednesday
8:00am - 7:00pm

Thursday
8:00am - 7:00pm

Friday
8:00am - 5:00pm

Saturday
9:00am - 11:00am

Sunday
Closed

LiveWell Chiropractic & Wellness Center

3456 Holiday Ct A
Bettendorf, IA 52722

(563) 332-7110