Patient Forms

New Patient and Wellness Check Forms
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Lifetime Family Wellness and Chiropractic offers our patient forms 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 forms from the list below that pertain to your visit, print them out and fill in the required information.
• Bring them with you on your first appointment.

New Patient Application For Care

Download Form

Wellness Check Questionnaire (Neuro Emotional Technique)

Fill out this questionnaire online. You will then be able to print it out and bring it to Dr. Burke for further evaluation.
Complete Form

There Is No Reason to Live in Pain

Schedule an Appointment