Online Forms

Steven B. Wasserman, R. N., D. C. offers our patient form(s) online so you can complete it 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.
  • Bring your printed and completed form(s) to your appointment or Fax them to (562) 430-7544.

New Patient Health History Form - Required

This let's us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

-----------------                                                              

Forms to Submit Online   

*Please fill out the forms below on your first visit or before your first appt. to (562) 430-4949

1. In Network Forms

2. Out-of-Network Forms

3. Medicare Forms

4. Monarch Managed Care Forms

5. Cash Forms

6. PI Forms

7. WC Forms

Locations

Find Us on the Map

Office Hours

Los Alamitos Office

Monday

8:00 am - 12:00 pm

2:30 pm - 6:00 pm

Tuesday

Closed

Wednesday

8:00 am - 12:00 pm

2:30 pm - 6:00 pm

Thursday

Closed

Friday

8:00 am - 12:00 pm

2:30 pm - 5:00 pm

Saturday

Closed

Sunday

Closed

Los Alamitos Office

Monday
8:00 am - 12:00 pm 2:30 pm - 6:00 pm
Tuesday
Closed
Wednesday
8:00 am - 12:00 pm 2:30 pm - 6:00 pm
Thursday
Closed
Friday
8:00 am - 12:00 pm 2:30 pm - 5:00 pm
Saturday
Closed
Sunday
Closed