WARNING

You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]

Follow Us

A Better Life Chiropractic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • 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.

Please print and complete the new patient forms below. Once complete, you may fax all pages to: (239) 263-8842. For your identity protection do not submit new patient forms via email.

New Patient Without Insurance:

Adult New Patient Form
Child New Patient Form

New Patients With Insurance:

Adult With Medical Insurance
Child With Medical Insurance

New Patient With Auto Accident Insurance:

Patient with Auto Accident Insurance

Records Release Forms:

Assignment of Benefits

Release of Records to ABLC

Release of Records from ABLC

(SE HABLA ESPANOL)



Click here to read our PRIVACY NOTICE