New Patient Forms

Adult Patient Questionnaire (Age 14+)
Pediatric Patient Questionnaire (Under Age 14)
Pregnancy Questionnaire
Webster Technique Consent 
Informed Consent & Acknowledgements (ALL New Patients Need to Print and Sign)

Privacy Policy (For Your Reference)

We offer digital forms for your convenience!
Follow the instructions below for completing our digital forms:

  1. Open the attachment and download to your computer. IMPORTANT: Do not complete the forms in your internet browser or it will not save your information.
  2. If the forms open in your web browser by default, close the window and open the PDF file using Adobe Reader. 
  3. Each form is a PDF document file. If you do not already have AdobeReader® installed on your computer, download for free: Get AdobeReader® FREE
  4. Complete all questions on the forms digitally. 
  5. Save the file to your computer with your first name and last initial.
  6. Attach and email the form to us at forlifetimewellness@gmail.com before your first visit.

Or, simply download, print, fill out and bring the completed hard copy with you to your new patient day, or plan on arriving 20 minutes early to fill out the forms in-office.

Call us with questions, 518.383.5595. We look forward to meeting you soon!