Online Forms

We offer our paperwork on line so you can complete it in the convenience of your own home.




Auto Injury New Patient Form

If your visit is the result of an auto accident, please fill out and sign our auto injury forms and bring them with you on your first visit.

 Download & Print Form




New Patient Packet

Please fill out and sign our health history and office expectations forms and bring them with you on your first visit.

 Download & Print Form




Chiropractic Lifecare of America

NO INSURANCE? LIMITED BENEFITS? Click the link below to learn about a discount program which could save you and your family up to 50% on select services.

www.clahealthcare.com




Free AdobeReader®

Each form is a PDF document file. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.

Dr. Zair Asks some important questions of interest to Peoria residents - Chiropractor Peoria Dr. Zair Asks...

Can babies with colic be helped with chiropractic?
It's probably one of the times a parent feels the most helpless. But based on the research, chiropractic and colic relief appear to go hand in glove. With success rates in the mid-90% range, more and more Peoria parents are seeing a chiropractor. If you have a baby with colic learn how chiropractic may help.
How could chiropractic help a stomach problem?
Chiropractic works by locating and reducing areas of the spine compromising nerve communications between your brain and your body. If nerves to or from your stomach are irritated, your stomach won't work right. Chiropractors find the source of the interference, reduce it and allow your body to work as designed.