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 

Download & Print Form

Download & Print Form ( Español)

Auto Injury New Patient Forms

Download & Print Form

Download the Free Adobe Reader®