If you need a more accessible version of this website, click this button on the right. Switch to Accessible Site

WARNING

You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]

760-753-0700

North County Integrative Health Center offers our patient form(s) online so you can complete 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 your printed and completed form(s) or bring it with you to your appointment.

New Patient Health History Form - Required

As you will soon learn, wellness chiropractic care can have global effects on the rest of your bodily functions. Many of our patients come in for neck pain or back pain, and once their nervous system is functioning better, many symptoms like fatigue, heartburn, anxiety, and digestion improve (the list goes on). Thank you for the honor of working with you on your path to optimal health.

Please let us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know! Please fill out the following New Patient Forms to your best ability prior to your first appointment. If you have any questions we will be more than happy to answer them when you arrive for your visit.

Form 1

Download & Print Form


New Patient Nutritional and Lifestyle Education Consultation Forms:

Lifestyle Education is very comprehensive. It includes: how you eat, how you sleep, what type of exercise you do, how much water you drink, and more. These forms will give Janice a broader view of how you currently live your life and how she can help you reach your health and wellness goals. Please fill out the following forms to your best ability prior to your first appointment.

Health History

Download & Print Form

Diet Diary and Exercise Log

(please fill out as accurately as possible 1 week prior to coming in for your initial consultation)

Download & Print Form


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form


Download the Free AdobeReader®

Exclusive Offer

Sign-Up Using the Form or Call Us at 760-753-0700

Office Hours

DayOpenClosed
Monday8:30 AM6:00 PM
Tuesday1:00 PM7:00 PM
Wednesday8:30 AM6:00 PM
ThursdayCLOSEDCLOSED
Friday8:30 AM2:00 PM
SaturdayAppointmentOnly
SundayCLOSEDCLOSED

What can we help you find?