Online Forms

Active Care Chiropractic offers our patient form(s) online so they can be completed it 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 form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.


New Patient Health History Form - Required

This lets 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


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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Office Hours

Day
Monday8am6pm
Tuesday9am5pm
Wednesday8am6pm
Thursday9am5pm
Friday8am - 6 pm(Every other Friday)
Saturday9am - 11am(By appointment)
Sundayclosed

To better serve our clients, we have made it easy for you to schedule and request your appointments - Click below to get started!

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Contact

Active Care Chiropractic
14156 Armargosa Road #G
Victorville, CA 92392
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  • Phone: 760-955-5558
  • Fax: 760-241-0449
  • Email Us

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