FORMS


Thank you for choosing Placentia Chiropractic for your health care needs.
Below you will find the forms necessary for our new and returning patients


BY FILLING OUT THE NECESSARY PAPER WORK BEFORE YOUR VISIT WE CAN GREATLY REDUCE THE AMOUNT OF TIME YOU ARE IN OUR OFFICE FOR YOUR FIRST VISIT.

THANK YOU!


PRIVATE PAY (CASH PATIENTS)


INSURANCE


ASHP


PERSONAL INJURY (CAR ACCIDENT OR SLIP AND FALL)


WORK INJURY - We accept workers comp injuries. However, due to the complexity of the workers comp system we do not have a standard set of forms due to the changing nature of the work comp system. Please give us a call to discuss your work injury.


Providing Chiropractic and Holistic health care to the residents of Placentia, Yorba Linda, Anaheim, Anaheim Hills, Brea, Fullerton and all of Orange County, Ca.