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Practice Name

Lifeline Chiropractic

Primary Location
2975 Fairview Road
Costa Mesa, CA 92626
Phone: 714-662-2142

Office Hours

DayMorningAfternoon
Monday9am - 11:30am2:45pm - 6pm
Tuesday9am - 11:30amClosed
Wednesday9am - 11:30am2:45pm - 6pm
Thursday9am - 11:30am2:45pm - 6pm
FridayBy Appt. OnlyClosed
SaturdayAppt OnlyClosed
SundayClosedClosed
Main Content

DO YOU WANT TO SAVE 20 MINUTES ON YOUR FIRST APPOINTMENT?

Lifeline Chiropractic offers our patient form(s) online so you can complete them in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary forms, print it out and fill in the required information.
  • Bring in your completed forms or fax it to our office: (714) 662-7957.


New Patient Health History Form - Required

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

Download & Print Form


Terms of Acceptance Form - Required

This form explains that we are Chiropractors and that we Adjust Vertebral Subluxations (Spinal Misalignments).  This Acceptance Form is Required.  Thank you.

Download & Print Form


Office Policy Form - Required

Standard Office Policy Information.  Also Required.

Download & Print Form


Child Information & Release form - Optional

This let's us know the history and current state of your child's health.  If this appointment is for a minor child, this form is required.

Download & Print Form


Auto Accident Form - Optional

If you were involved in a Motor Vehicle Accident then this form is required.

Download & Print Form


Work Injury Report Form - Optional

If you were injured on the job then this form is required.

Download & Print Form  

 


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form


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 3D Spine Simulator

Online Forms

Lifeline Chiropractic offers our patient form(s) online so they can be completed in the convenience of your own home or office.
Download Online Forms Here

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Make an Appointment

We will do our best to accommodate your busy schedule. Request an appointment today!

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Services

We strive to provide complete care for our patients. Learn more about all the services we provide.

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Contact

Lifeline Chiropractic
2975 Fairview Road
Costa Mesa, CA 92626
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Office Hours

DayMorningAfternoon
Monday9am - 11:30am2:45pm - 6pm
Tuesday9am - 11:30amClosed
Wednesday9am - 11:30am2:45pm - 6pm
Thursday9am - 11:30am2:45pm - 6pm
FridayBy Appt. OnlyClosed
SaturdayAppt OnlyClosed
SundayClosedClosed
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Member Wellness