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Patient Portal

Active Chiropractic Health & Wellness 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

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! 

NEW PATIENT FORMS (Download & Print)


**Please also print the disability index below that relates to your main area of complaint (if applicable).

Headache Disability Index

Neck/Upper Back Pain Disability Index

Low Back Pain Disability Index

Functional Rating Index**

(**For those with multiple problem areas or seeking general wellness care) 

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 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 the Free AdobeReader®

THIS ---->https://activechw.chiromatrixbase.com/new-patient-center/online-forms.html

Office Hours

Monday7:30 - 12:003:00 - 6:00
Tuesday9:00 - 12:003:00 - 6:00
Wednesday7:30 - 12:003:00 - 5:30
Thursday9:00 - 12:003:00 - 6:00
Friday7:30 - 12:00Closed
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
7:30 - 12:00 9:00 - 12:00 7:30 - 12:00 9:00 - 12:00 7:30 - 12:00 Closed Closed
3:00 - 6:00 3:00 - 6:00 3:00 - 5:30 3:00 - 6:00 Closed Closed Closed


Thank you for the wonderful treatments that helped my body feel better. It's great to be able to walk without pain and to be able to dance!

Norman, OK

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