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) 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!
*Chiropractic patients, please fill out the forms below on your first visit or before your first appointment.
1. In Network Forms
Extra Questioner Injury Forms for Auto and Workers Compensation Injuries Only:
1. Pain Scale-VAS
2. Pain chart
3. Neck questionnaire
4. Low back questionnaire
5. Upper extremity questionnaire
6. Lower extremity questionnaire