Thank you for choosing Living Well Chiropractic and Welcome to our office!


Click the link below to fill out our New Patient Intake Form online.This Form MUST  be completed prior to your first appointment as a new patient. In order for us to get a better idea of your symptoms and health history, please fill out the form in it’s entirety, being as accurate and honest as possible. All of the information in this form must be collected for your health records and for insurance purposes.

Please note: DO NOT SKIP ANY SECTIONS OF THE FORM. If you skip sections the information will still have to be collected by staff during the intake which may take more time.

Once you are done filling out the form, please be sure to click “Submit” at the bottom. If you have any questions about or need help with our online form, please call our office at (785) 826-9911.

PLEASE NOTE…THIS FORM WILL ONLY WORK WITH INTERNET EXPLORER, CHROME AND FIRE FOX

Click here to fill out our New Patient Intake Form