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Exclusive Offer

Military (active and veterans), first responders and corrections officers always receive 10% off all services to thank you for your dedication to protect us!

(Does not apply to Medicare Part B participants)

Sign-up using the form or call me at 325-703-1022 or call or text my cell phone 510-432-2924 to take advantage of this exclusive offer.

American Veterinary Chiropractic Association (AVCA) - certified in animal chiropractic. Dog, cat, horse and other animal chiropractic available with veterinary referral.

Call or text my cell phone 510-432-2924 to schedule your appointment.

Activated Life Chiropractic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Click on the green "https" link below and fill in the required information. Click on the captcha to let us know your are real.
  • Sign and click submit and it will come to the office. This will also make your first visit a little faster.

Online 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! Click the link below, fill out the information, sign, click the captcha to let us know you are a real person and click submit.


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 chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor, 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

Download the Free AdobeReader®

Featured Services

We strive to provide complete care for our patients. Learn more about all the services we provide.
Make An Appointment
We will do our best to accommodate your busy schedule. Schedule an appointment today!
Online Forms
Our patient forms are available online so they can be completed in the convenience of your own home or office.