3456 Holiday Court
Bettendorf, IA 52722
Ph: 563-332-7110
Fax: 563-332-7234
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Thank you for choosing LiveWell Chiropractic as your care provider. Your journey towards a better you starts here. Please use the links below to submit forms online, making your appointment more efficient and allowing you more face to face time with your provider.

New Patient: Chiropractic Intake Form

New Patient: Massage Intake Form*

New Patient: Acupuncture Intake Form*

*These forms are in Adobe PDF format. Click here to download the free Adobe Reader.
NOTE: New patient forms cannot be submitted on a smartphone but can be done on a computer or tablet.