Please print off any of the following forms you may need before visiting our clinic.¬† If a problem occurs downloading forms, they are available to fill out in the office.¬† Baylee or Cathie will be happy to help you!
- Personal Health History
- Patient Health Information Informed Consent Form
- Patient Intake Form
- Informed Consent to Treat
- Cash Payment Financial Agreement
- Vehicle Accident Information
- Notice of Doctor Lien
- Personal Injury History
- Personal Injury Financial Agreement
Placentia-Linda Chiropractic is accepting new patients now!¬† We are currently¬†accepting the following:
- Health Insurance Coverage¬†– Please call and find out whether we are in your provider network.
- Personal Injury Claims¬†– If you have been involved in an automobile accident, call us now!
- Cash Plans¬†– If you do not have insurance, call us and we will work with you to get the care and treatment you need.
- Athletic Team Plans¬†– Call for group rates such as treatment for sports teams.
- Chiropractic Maintenance Plans¬†– Some people just need an adjustment every once in a while.¬† We can do that too!
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