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New Patient Form


Please fill out the following form and bring this to our office at the first treatment. All information provided is strictly confidential.


Confidential Patient Case History (PDF format)

San Mateo Clinic
Mon 8:30AM-11:00AM
Tue 2:00PM-4:30PM
Wed 8:30AM-11:00AM
Thu 2:00PM-4:30PM*
Fri 8:30AM-11:00AM
Sat 12:00AM-1:00PM
Sun Close
*Appointment Only
San Jose Clinic
Mon 12:00PM-6:30PM
Tue 9:00AM-11:30AM
Wed 12:00PM-6:30PM
Thu Close
Fri 12:00PM-6:30PM
Sat 8:00AM-11:30AM
Sun Close