Blue Cross/Blue Shield
Patient Financing Available
Patient History Forms
Before your first visit our office, you might be asked to fill out and print one of the following patient history forms, and bring it with you.
1. Short Form Fill out online, then print, or print first, then fill out by hand
2. Long Form A Fill out online, then print, or print first, then fill out by hand.
3. Long Form B This form is not filled out online; print form first, then fill out by hand.
DISCLAIMER: No individuals, including those under our active care, should use the information, resources or tools contained within to self-diagnose or self-treat any health-related condition. Diagnosis and treatment of all health conditions should only be performed by your doctor of chiropractic or other licensed health care professional.
This web site is the creation of Spectrum Web Design, 2524 Bonnie Brook Drive Stockton CA 95207-1304
(209) 473-8423 (800) 506-5866 Questions about this site: Email JFAlward@aol.com.