O’Hara Chiropractic In Santa Barbara

Admitting Paperwork

We offer our paperwork on line so you can complete it in the convenience of your own home. Here are the essential forms we use and why we need them.

Intake Forms

This let’s us know what’s happened, but perhaps more important, where do you want to take your health?

Download & Print Form (English) | Descargar e imprimir formulario (español)

HIPAA Notice

Download & Print Form

Free AdobeReader®

Each download is a PDF document file. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.

Request a Consultation

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Patient Type

New Patient

Current Patient

Returning Patient

First Name

Last Name

Email Address

Phone Number

Respond to me via:

Email

Phone

Preferred Day/Time:

Date

Hour H123456789101112

Hour M00153045

AM or PM

AM

PM

Comments or Questions

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Please keep in mind that communications via email over the internet are not secure. Although it is unlikely, there is a possibility that information you include in an email can be intercepted and read by other parties or unauthorized individuals. Please do not include personal identifying information such as your birth date, or personal medical information in any emails you send to us. Communication via our website cannot replace the relationship you have with a physician or another healthcare practitioner.

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