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New Patient Forms

Man filling out paperworkActive Chiropractic Health & Wellness offers our patient form(s) online so they can be completed in the convenience of your own home or office.

New Patients

  • Click on the PATIENT PORTAL link to enter.
  • Enter your last name and the PIN that was given to you when you made your appointment. It will then ask you to change it to another 4 digit PIN.
  • Once in the portal, click the New Patient link and enter all required information on each tab.

PATIENT PORTAL »

Pediatric Patients

​Patients that are EIGHT years old and under, please download and print the additional pediatric forms below.
PDF PAPERWORK »

Returning Patients

You can access the portal to update information, check future appointments, and print your own receipts and superbills.
PATIENT PORTAL »

New Patient Forms | (405) 321-9300