Fax: (661) 873-4164
Elite Chiropractic offers our patient form(s) online so they can be completed it in the convenience of your own home or office.
- If you do not already have AdobeReader® installed on your computer, Click Here to download.
- Download the necessary form(s), 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.
Patient Information Forms
This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? The following forms are required for all patients new to Elite Chiropractic:
- Patient Information - Complete all 3 pages as thoroughly as possible
- Consent to Treatment - Sign and date
- Consent for Purposes of Treatment, Payment & Healthcare Operations - Sign and date
- Notice of Privacy Practices - Read only
Member Wellness Registration Form - Optional
This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!Download & Print Form
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Dr. Reyes is a FANTASTIC chiropractor! He took the time to talk with me and go over my issues (without rushing me!) and thoroughly explained what he would be able to do to help me. I felt immediate relief after my adjustment.
- Nick P. / 7/27/2012
Launch 3D Spine Simulator
Meet the Chiropractic
Since then, he has acquired invaluable experience as a chiropractor, fine-tuning his adjusting technique. In 2007, Dr. Reyes and his family moved to Bakersfield and for the past two and a half years, has strengthened his reputation as a capable and compassionate chiropractor.Read More