New Patients

New Chiropractic Patients

Patient Form for Chiropractic Care

Click the button below to fill out our New Patient Intake Form online. This Form should be completed prior to your first appointment as a new patient. If you are unable to complete the form, call us. We can help. For us to have a better idea of your symptoms and health history, please fill out the form in its entirety, being as accurate as possible. All the information in this form should be collected for your health records and to comply with insurance requirements.
Fill Out Our New Patient Intake Form
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 will take more of your 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 FIREFOX

Interested, but not ready to make an appointment?

Maybe you’re still skeptical about chiropractic care, or you want to see what makes our PulStar technology different than other kinds of treatments. We understand. That’s why we offer free educational demonstrations. Come in and see for yourself how our office and the technology works. Our doctors can answer some of your questions with a phone call.

Try a new and different approach to pain relief and wellness by choosing Living Well Chiropractic in Salina, KS. No matter how hopeless you feel your case is, we may be able to help. We are the only practice in the North Central Kansas area that offers the advanced PulStar technology. It provides computerized analysis of your spinal joints and performs adjustments based on those analyses. This is a truly customized unique form of chiropractic care. We offer treatment for back, neck, and foot pain, and more. 

Skeptics are very welcome.

What Should You Expect at Your First Visit?

  • When you come in for your initial visit, we’ll sit down and talk with you about your detailed health history and your current situation and how it limits your daily activities. By completing our online new patient intake form will help us and save you time on your first visit. Complete the onlinenew patient intake form here.
  • Then we’ll conduct our unique bio-mechanical examination. We’ll test your range of motion, muscle strength, and even your reflexes. We also examine shoulders, elbows, wrists, hips, knees, ankles and feet. (Learn more about extremity care). If x-rays are needed, they can be taken with our digital x-ray technology. If you have any previous reports or images that may be relevant to your case, please bring them with you.
  • After the exam is complete, we’ll discuss our findings, then give you a realistic view of what we can do to help you. In many cases, we can improve or solve the root causes of your pain and conditions. We will only accept your case if we sincerely believe we can help you.
  • We’ll also discuss your future treatment.
Learn more about what a typical treatment session will look like once you get started.

Call us at 785-826-9911 to set up your appointment.
Have questions about our office, or want to schedule a free educational demonstration or consultation? 
Contact us today at 785-826-9911. Be sure to check out our health talks and community outreach events to learn more! 
We look forward to working with you!
Call 785-826-9911
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