LiveWell Wellness Centers offers our patient form(s) online so you can complete it in the convenience of your own home or office.

Once you complete the form, simple click "Submit".  We will review your answers in preparation for your first visit. 

New Patient Intake Form

This let’s us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Insurance Verification Form

Curious to know if your health insurance will contribute to your care?  Complete this form and we will be happy to call to verify benefits and coverage.  

New Patient Intake Form - Children 12 and Under

We are very proud to provide care for people of all ages.  Dr. Komeshak is a pediatric specialist, certified by the International Chiropractic Pediatric Association. 

Complete this form and let us know how we can help your child improve their health. 

Injury Questionnaire

Have you been injured in an accident?  Complete this form to tell us about the accident. 

NOTE:  Please complete the NEW PATIENT INTAKE FORM, TOO.

 Massage Therapy Intake Form

Scheduled for a massage therapy appointment?  This form tells us all we need to know in order to make your LiveWell massage remarkable.  One of our doctors will personally review your information to ensure the delivery of a safe, effective treatment.