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100 Year Lifestyle Chiropractor in Kent WA
Phone: (253) 854-3040
Make Your Health a Priority!

Request an Appointment

Patient Forms


Please download these forms and complete them prior to your first visit. Bring the completed forms, along with your insurance information, with you and arrive for your appointment 15 minutes prior to your scheduled time. We look forward to seeing you!


Terms of Acceptance

Chiropractic health care terms of acceptance form.


Personal and Family Health History

Please fill this form and bring it with you on your first visit to our practice.


Patient Information (page 1 of 2)



Patient Information (page 2 of 2)



Patient's Point of View Care Description



Health Profile



Terms of Acceptance



Ken-East Financial Policy



Visual Symptom Chart



Health Questionaire