Accessibility View Close toolbar

Aligned for Life Chiropractic

91 Newport Pike, Suite 302-303

Gap, PA 17527 9609 United States

(610) 979-0415

New Patient Forms

Aligned for Life Chiropractic offers our patient form(s) online so they can be completed in the convenience of your own home or office.

To save our new patients time, please click on the link below to download the editable PDF of our Adult/Child Health Record. Please complete all the fields, print, sign/date and bring to your first appointment. Thank you!

  • If you do not already have AdobeReader® installed on your computer, click here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Adult Health Record

Download & Print Form

Child Health Record (under 15 years old)

Download & Print Form


You'll need Adobe Reader to view & edit these files.

Download the Free Adobe Reader®

CONTACT US TODAY

We look forward to hearing from you

Location

Find us on the map

Office Hours

Our Regular Schedule

Monday:

3:00 pm-7:00 pm

Tuesday:

9:00 am-1:30 pm

Wednesday:

3:00 pm-7:00 pm

Thursday:

available as needed

Friday:

available as needed

Saturday:

Closed

Sunday:

Closed