Online Forms

Living Pure Chiropractic & Acupuncture offers our patient form(s) online so they can be completed in the convenience of your own home or office. To schedule with Dr. Dias please send a message here.

  • 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) to 623-566-4918 or bring them with you to your appointment.
  • We ask that you arrive 15 min early with completed forms, 40 minutes early to fill out forms in our office!

New Patient Health History Form 

Complete your New Patient Forms Online


Download & Print Form

Download & Print Form ( Español)

Good Faith Estimate Form - Initial Visit

Download & Print Form

Download the Free Adobe Reader®




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