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Online Forms

Canton Chiropractic Life Center offers our patient form(s) online so they can be completed 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.

Select Disability Index Specific to your condition

Must be Filled out 1st Day

Patient Introduction Form

Terms of Acceptance

General Pain Disability Index Questionnaire

Neck Pain Disability Index Questionnaire

Revised Chronic Low Back Pain Disability Questionnaire

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!

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Our Location

Office Hours

Canton Chiropractic Hours


9:00 am-1:00 pm

3:00 pm-7:00 pm


3:00 pm-6:00 pm


9:00 am-1:00 pm

3:00 pm-7:00 pm




9:00 am-1:00 pm

3:00 pm-6:00 pm