New Patient Intake

Click the link below to complete & submit our new patient intake.   All information submitted is encrypted and secured.

Completion of this form helps us understand your health history and the current state of your health and wellness.

***Completing this form does NOT create an appointment as a new patient.  Please call the office to schedule your new patient appointment.

https://intake.mychirotouch.com/?clinic=HFC0079

Consent for Use and Disclosure of Health Information & HIPPA Notice of Privacy

About your Insurance

Consent for Text-Email Notification

Financial Responsibility

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