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100 Year Lifestyle Chiropractor in Miami FL
Phone: (305) 271-7447
Make Your Health a Priority!

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Patient Forms


We offer our patients form(s) online so you can complete it in the convenience of your own home or office.

Click the link New Patient Online Form below, fill out the form completely and leave no blanks, digitally sign and click submit. Forms will automatically be sent to us and uploaded in our software. (Scroll to the bottom of the forms page to be sure that you can sign forms digitally from your computer. If not, you will not be able to complete the process online and will need to complete the forms in the office)


New Patient Online Form

Detox Questionnaire

Do you feel sluggish? Are you constantly fighting off colds, flu and allergies? Are you bloated? Craving sugary foods? Fighting a foggy brain? If you answered a resounding "yes!" to any of these bothersome issues, a detox or supplements might be exactly what your body needs.



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