Welcome to Our Online Forms Page 

In this section of our website, you will be able to take care of the items necessary for your first chiropractic visit prior to arriving, in the comfort of your own home.  You are welcome to print and fill out these forms, and bring them with you, OR You can use the Fill Online Links (Orange) to fill online and submit them directly to our secure system.

Please do not date your forms since the forms need to have the date of your actual appointment.

If you have any questions at any time, please don't hesitate to contact our office @ 951-323-7783 !

All New Patients with the acception of Auto Accident Cases          

 

 

 

 

All Returning Patients:

  •   If you haven't been seen in the last 3 months, please fill out this form: 

       

         Established Patient Form.

 

PLUS: (All new and Returning Patients must fill out one or more of the following forms, depending on your complaints. If there is no pain in any of the following parts please skip these forms.

 

 

 

Additional Forms for Specific Insurances

Patients with United Healthcare & Any Plan thru Optum Health must fill out the following 2 forms in addition to Patient intake forms and the Indexes according to your primary complaint.  Thank you.

 

 

Plus

Chiropractic &/or Massage Therapy Hours: (By Appointment Only-

No walk-ins please)

Monday        8:30 am-2:30 pm

Tuesday        8:30 am-2:30 pm

Wednesday  8:30am-1:00 pm

Thursday      8:30am-2:30 pm

Friday           8:30 am-2:30 pm

Sat. & Sun.  Closed.

 

 

Massage Therapy Only Hours:

(No Chiro. Appts. -By Appointment Only-No walk-ins please)

 

Monday               3:00-6:00 pm.

Tuesday               3:00-7:00 pm.

Wednesday         3:00-6:00 pm.

Thursday             3:00-7:00 pm.

Friday                  3:00-6:00 pm.

Sat.                       9:00-1:00 pm. 

                              3:00-5:00 pm

Sun.                      Closed.

 

To make an appointment please:

                        

                        CALL US

           951-323-7783

                         

                          OR

For an appt. with Dr. Elgendy, and/or WITH one of our licensed massage therapists:

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