Action Chiropractic Clinic offers our patient form(s) online so they can be completed 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.
- Fax us at (831)426-4854 your printed and completed form(s) or bring it with you to your appointment.
New Patient Health History Form - Required
This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
This notice describes how health information about you may be used and disclosed and how you can get access to this infomration.
Informed Consent Form - Required
This form gives your consent to the practice that you're willing to undergo chiropractic procedures.
Assignments of benefits - Required
This form allows us to receive payments from your insurance companies directly to the doctor.