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ONLINE PATIENT FORMS

We offer our patient forms ONLINE.  Simply print the forms below and bring them in with you on your appointment.


#1 – Patient Information

Please DOWNLOAD and PRINT

A) Patient Information Forms

This let’s us know what’s happened, but perhaps more important, where do you want to take your health?

pdf iconDownload & Print Form


B) Is the patient under 18?

Click on the link below to fill out our consent to treat a minor.

pdf iconDownload & Print Form


#2 – Sports Physical Evaluation

Click on the link below to fill out our Physical Evaluation form.

pdf iconDownload & Print Form


#3 – Automobile Accident Questionnaire

If your health issue is the result of a car accident, we need some additional information.

pdf iconDownload & Print Form


#4 – Workers Compensation Questionnaire

If your health issue is the result of a work place accident please fill out this form.

pdf iconDownload & Print Form


#5 – Authorization to Release Records

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Free AdobeReader®

Each form is a PDF document file. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.


Four Times Voted #1 for “Best Chiropractor in San Bernardino County”
Chiropractic Website by Perfect Patients.