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100 Year Lifestyle Chiropractor in Los Altos CA
Phone: (650) 941-7973
Make Your Health a Priority!

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Patient Forms


Please download these forms and complete them prior to your first visit. Bring the completed forms, along with your insurance information, with you and arrive for your appointment 15 minutes prior to your scheduled time. We look forward to seeing you!


Terms of Acceptance

Chiropractic health care terms of acceptance form.


Personal and Family Health History

Please fill this form and bring it with you on your first visit to our practice.


Animal Chiropractic - Vet Referral Form

Download a Vet Referral Form in PDF format
Please note that The State of California requires a veterinary referral prior to your animal receiving chiropractic care. It is important to keep in mind that chiropractic care is not a substitute for veterinary care. We work with many of the bay area veterinarians and would be happy to establish a relationship with your DVM if we have not worked together in the past.