• 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) 381-9777.

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!

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*Chiropractic patients, please fill out the forms below on your first visit or before your first appointment.
1.  In Network Forms

2.  Out-of-Network Forms

3.  Medicare Forms

4.  Optum/Monarch Forms

5.  Cash Forms

6.  Laser Forms

7.  PI Forms

8.  WC Forms

Extra Question Injury Forms:

1. Pain Scale-VAS
2. Pain chart
3. Neck questionnaire
4. Low back questionnaire
5. Upper extremity questionnaire
6. Lower extremity questionnaire

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