Huntington Beach Upper Cervical ChiropracticHuntington Beach Upper Cervical Chiropractic
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(888) 857-5510Book Consultation

New patient forms

Fill out the form that matches your situation. Your entries save automatically on this device, so you can come back and finish later. When you're done, print the form and bring it to your appointment.

  • New Patient Health HistoryStandard intake form for new patients. Captures your health history, current complaints, and a list of common symptoms so Dr. Smith can prepare for your first visit.
  • Accident / Personal Injury FormUse this form if you were referred after a car accident or workplace injury. Captures insurance, claim, and accident-specific details in addition to your symptoms.
Huntington Beach Upper Cervical Chiropractic

Specialist care for the cases other doctors couldn't solve.

Specialist in upper cervical chiropractic.

3D imaging for precise diagnosis.

Quick Links

  • Home
  • Book Consultation
  • Why Upper Cervical
  • What to Expect
  • Meet Dr. Smith
  • Patient Stories
  • New Patient Center
  • Conditions We Treat

Contact Information

  • 16052 Beach Blvd. Ste. 130
    Huntington Beach, CA 92647
  • (888) 857-5510
  • Fax (714) 848-2968
  • info@hbucc.com

Office Hours

  • Monday & Thursday
    9:00 am - 1:00 pm, 3:00 pm - 6:00 pm
  • Tuesday
    9:00 am - 1:00 pm, 3:00 pm - 4:00 pm
  • Wednesday
    Closed
  • Friday
    9:00 am - 2:00 pm
  • Saturday
    9:00 am - 11:00 am
  • Sunday
    Closed
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