Patient Intake Form

We are so confident in what we do your consultation and first treatment are free!

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Download Your Patient Form Prior to Your Appointment

To speed your initial appointment and better help us understand your pain conditions, please fill out a patient information form.

Form Options

1. Download and print the form, complete the form, and bring the completed form with you on your first visit.
OR
2. Arrive at least 30 minutes prior to your appointment and we will provide the forms for you to fill out.

Contact Pain Free Life Centers today with any questions you have regarding your form.
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Call for your free consultation and first treatment!

No drugs, no injections, no surgery, no side effects

(248) 418-4162

(248) 418-4162

Learn More About

Pain Free Life Centers

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"Highly recommend this pain control clinic! Very happy with the results—I’ve finally gotten some relief for my back pain. The staff is always very nice and accommodating and I look forward to my appointment every time."

- Zaprianka Sivrieva