Performance Chiropractic Center 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. If you have any questions, PLEASE bring the forms with you and we will be happy to answer them for you. 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) to 925-687-5588 or scan to [email protected] 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!
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!
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!
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!
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!
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!