If you need a more accessible version of this website, click this button on the right. Switch to Accessible Site


You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]

Gilcher Chiropractic Life Center 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, and then fill in the required information.
  • Fax to us your printed and completed form(s) or bring it with you to your appointment.

New Patient Adult Health Form  

This lets us know your history and current state of health. Which questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

New Patient Child - Under 18 Health Form  

Download & Print Form

 Privacy Practices Notice 

Download & Print Form

Patient Centered Medical Home (PCMH)

Download & Print Form

Member Wellness Registration Form - Optional

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

Download & Print Form

Download the Free AdobeReader®

Like Us on Facebook

Sign up to be a website member!

THIS ---->https://gilcher-chiro.com/online-forms.html

Office Hours

The office will be CLOSED:
Saturday, May 26th
Monday, May 28th

Have a safe Memorial Weekend!

Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9:30 - 1:00 Closed 9:30 - 1:00 Closed 9:30 - 1:00 By Appointment Closed
3:00 - 7:00 Closed 3:00 - 7:00 Closed 3:00 - 7:00 Closed Closed

Newsletter Sign Up