5033

Skip to content

BOOK AN APPOINTMENT CHIROPRACTIC MASSAGE, STRETCH THERAPY, & ACUPUNCTURE
google social button facebook social button instagram social button
Request Appointment
CALL (403) 995-0855

Family Legacy Chiropractic

Home
About Us
- Blog
Meet the Team
Our Services
New Patients
- New Patient Forms
Contact Us

woman at her computer looking at forms

Family Legacy Chiropractic
New Patient Forms

Save Time During Your First Visit

At Family Legacy Chiropractic, we offer our paperwork online so you can complete it in the convenience of your own home.

Adult Patient Intake Forms
Child Patient Intake Forms

divider

Family Legacy Chiropractic New Patient Forms | (403) 995-0855

Email Family Legacy Chiropractic

Comments, Requests, Questions, or Suggestions

First Name

Last Name

Respond to me via:

Email

Phone

No Response

Email Address

Phone Number

I agree to refrain from including any personally identifiable information or protected health information in the comment field. For more info, read disclaimer.

Please keep in mind that communications via email over the internet are not secure. Although it is unlikely, there is a possibility that information you include in an email can be intercepted and read by other parties or unauthorized individuals. Please do not include personal identifying information such as your birth date, or personal medical information in any emails you send to us. Communication via our website cannot replace the relationship you have with a physician or another healthcare practitioner.

I consent to having this website store my submitted information so they can respond to my inquiry. For more info, read our privacy policy.

By providing your phone number, you consent to receive text messages from Family Legacy Chiropractic, including appointment reminders and care-related communications. Message and data rates may apply. Message frequency varies. Reply STOP to opt out at any time.

Leave this empty:

Request Appointment (pending confirmation)

Patient Type

New Patient

Current Patient

Returning Patient

First Name

Last Name

Email Address

Phone Number

Respond to me via:

Email

Phone

Preferred Day/Time:

Date

Appointment Hour

Appointment Minute

AM or PM

AM

PM

Comments or Questions

I agree to refrain from including any personally identifiable information or protected health information in the comment field. For more info, read disclaimer.

Please keep in mind that communications via email over the internet are not secure. Although it is unlikely, there is a possibility that information you include in an email can be intercepted and read by other parties or unauthorized individuals. Please do not include personal identifying information such as your birth date, or personal medical information in any emails you send to us. Communication via our website cannot replace the relationship you have with a physician or another healthcare practitioner.

I consent to having this website store my submitted information so they can respond to my inquiry. For more info, read our privacy policy.

By providing your phone number, you consent to receive text messages from Family Legacy Chiropractic, including appointment reminders and care-related communications. Message and data rates may apply. Message frequency varies. Reply STOP to opt out at any time.

Leave this empty:

Family Legacy Chiropractic
202-106 Southbank Rd.
Okotoks, AB T1S 5V4
Phone: (403) 995-0855

Copyright
Legal
Privacy
Cookies
Accessibility
Terms of Service
Sitemap

Chiropractic Websites by Perfect Patients

We use cookies and similar tracking technologies to analyze site usage, enhance our services, and deliver personalized content. We require your active consent to enable these cookies. You can customize your preferences or withdraw your consent at any time. Privacy Policy

Your browser’s Global Privacy Control setting is on, so we have treated it as an opt-out. Choosing “Accept” will allow these cookies on this site anyway.