Skip to Main Content

100 Year Lifestyle Chiropractor in Dunwoody GA
Phone: 770-391-2771
Make Your Health a Priority!

Request an Appointment

Patient Forms

Initial Health Intake Form

Health Intake Form



Electronic Health Records Intake

Please fill out demographic information and let us know any allergies you may have and any medications your are currently taking.



Terms of Acceptance

Please sign stating you understand that we treat certain ailments in our clinic using specific chiropractic methods.



Informed Consent

Please sign stating that you understand what chiropractic care is and consent to our treatment.



HIPAA

Please sign stating that you understand and agree to our notice of privacy policies.



Clinic Policies

Please sign stating that you have read and understand our clinic policies.



Minor Consent

If patient is under the age of 18 please sign confirming your consent to treat. Additional minor paperwork will be provided upon arrival in the office.