4425 Treat Blvd. Suite B Concord, CA 94521

Online Forms

Performance Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office. Please contact our office for our updated fee schedule.  Thank you.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the appropriate form(s) depending on your insurance or type of case. 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.

Cash / Kaiser Healthy Choice Patient Forms - Required (if applicable)

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form


Workers Comp. Patient Forms - Required (if applicable)

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form


General Insurance Patient Forms - Required (if applicable)

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form


Automobile/Personal Injury Patient Forms - Required (if applicable)

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form


Medicare Patient Forms - Required (if applicable)

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form


Spanish Forms - Required (if applicable)

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form


Download the Free AdobeReader®

CONTACT US TODAY

We look forward to hearing from you

Location

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Office Hours

Our Regular Schedule

Monday:

9:00 am-12:00 pm

2:30 pm-6:00 pm

Tuesday:

2:30 pm-6:00 pm

Wednesday:

9:00 am-12:00 pm

2:30 pm-6:00 pm

Thursday:

9:00 am-12:00 pm

2:30 pm-6:00 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed