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1800 S. Robertson Blvd., Ste. 1 Los Angeles, CA 90035
310-203-0500
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Back & Basics Chiropractic and Fitness offers our patient form 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, print it out and fill in the required information.
  • Fax us your printed and completed form or bring it with you to your appointment.


New Patient Health History Form - Required

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!

Download & Print Form


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