ACI Clinic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our 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 Health History 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!
Download & Print Intake FormDownload & Print HIPPA Form
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 chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor, 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 FormDownload the Free AdobeReader®
Categories
ACI Services
Conditions We Treat
Community Content
Member Wellness
Welcome Guest!
Want access to members only content?
Sign in with your account, or register to become a member below.
Kirkland Clinic
1313 Market Street Suite 3000
Kirkland, WA 98033
Mon, Wed, Fri: 8am - 6pm
Tue, Thu: 8am - 7pm
Sat: 9am - 4pm
Sun: By appointment only

Target Plaza
18205 Alderwood Mall Pkwy, Suite K
Lynnwood, WA 98037
Mon - Sat: 10am - 10pm
Sun: 10am - 8pm
Contact
Lynnwood: (425) 778-1188
Fax: 425-285-9018
E-mail: info@aciclinic.com
Leave us a massage
