Total Life Clinics 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 Intake 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!

Please print, fill Out and bring in on your first appointment:  Patient Intake Form

Privacy Notice (Please read, print last page and sign.) Click Here

Terms of Acceptance (Please read, print and sign.)  Click Here

Child Consent Form (If under 18 years of age.) Click Here

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 print it out and bring it in to our office 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


Please print, fill Out and bring in on your first appointment.

Metabolic Health Profile

Your Last Diet


Please print, fill Out and bring in on your first appointment.  

Patient Intake Form



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Contact

Get Directions
 
Total Life Chiropractic

Norridge Wellness Clinic  
7830 W.  Lawrence Ave.
Norridge, IL 60706 
Phone: 708 457.8000
 
Willow Springs Wellness Clinic 
8240 S. Wolf Road 
Willow Springs, IL 60480 
Phone: 708 839.4852
Get Directions
  • Phone: 708-457-8000
  • Fax: 708-457-1333
  • Email Us

Office Hours

Day
Monday9:00am to 12:00pm3:00pm to 7:00pm
TuesdayClosed3:00pm to 7:00pm
Wednesday9:00am to 12:00pm3:00pm to 7:00pm
ThursdayClosedClosed
Friday9:00am to 12:00pm3:00pm to 7:00pm
Saturday9:00am to 12:00pmClosed
SundayClosedClosed

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