Online Forms

New Patient Form


Welcome! If you are planning your first visit to Active Family Chiropractic & Acupuncture, we look forward to meeting you! To save time on your first visit, we encourage you to download, print, and fill out our new patient forms below.

If you do not already have AdobeReader® installed on your computer, Click Here to download it now.

  • Download the necessary form(s), print it out and fill in the required information.

  • Complete your forms and bring them in with you to your appointment or email them to the office you will be visiting
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Forms


Formas en Español

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  • Lesiones automovilísticas / lesiones personales

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Roya1234 Holistic Treatments Health and Wellness Coaching How Chiropractic Can Help With Weight Loss Cranial Facial Release Physiotherapy Treatments Therapeutic Adjustments Massage Therapy Trigger Point Injections 8:00 am - 6:00 pm 8:00 am - 6:00 pm 8:00 am - 6:00 pm 7:30 am - 6:00 pm 8:00 am - 6:00 pm Closed Closed chiropractor https://www.google.com/search?rlz=1C1JPGB_enUS814US814&ei=pUIJXbvMEODB0PEPiuqTiA8&q=active+family+gi&oq=active+family+gi&gs_l=psy-ab.3..0i22i30l10.31447.31503..31737...0.0..0.74.147.2......0....1..gws-wiz.......0.x2MB5ODwxO0#lrd=0x879986c3a3cd15af:0x7522e7b440ff2d25,3,,, https://www.yelp.com/writeareview/biz/fOBijqTvTDYrSVjKg2iD-A?return_url=%2Fbiz%2FfOBijqTvTDYrSVjKg2iD-A&source=biz_details_war_button https://www.facebook.com/activefamilygi/reviews/?ref=page_internal https://www.google.com/maps/place/Active+Family+Chiropractic+%26+Acupuncture/@40.9245111,-98.378611,19.25z/data=!4m5!3m4!1s0x0:0x7522e7b440ff2d25!8m2!3d40.924615!4d-98.3782349 https://www.facebook.com/activefamilyhastings/ https://goo.gl/maps/p5voSzocGzNPwZAc7 https://www.youtube.com/channel/UCDhFRb9p2Y53xsS4T9I793g https://www.yelp.com/biz/active-family-chiropratic-and-acupuncture-hastings activefamilyhastings@gmail.com 4022495500 3602 Cimarron Plaza #340
Hastings, NE 68901 8:00 am - 6:00 pm 8:00 am - 6:00 pm 8:00 am - 6:00 pm 1:00 pm - 6:00 pm 8:00 am - 6:00 pm Closed Closed https://www.google.com/maps/place/Active+Family+Chiropratic+%26+Acupuncture/@40.6213083,-98.3853218,19.5z/data=!4m5!3m4!1s0x0:0x1a2533ac93237ab7!8m2!3d40.6213856!4d-98.3848041 208 S. Burlington Ave. #103A
Hastings, NE 68901 2441 North Diers Ave.
Grand Island, NE 68803 3083844955 8:00 am - 6:00 pm 8:00 am - 6:00 pm 8:00 am - 6:00 pm 7:30 am - 6:00 pm 8:00 am - 6:00 pm 8:00 am - 11:00 am Closed https://www.google.com/maps/place/2441+Diers+Ave,+Grand+Island,+NE+68803,+USA/@40.9449425,-98.3849747,20z/data=!4m5!3m4!1s0x87998725466f956d:0x5d4570c9b2543778!8m2!3d40.945031!4d-98.38459