The Belmont Chiropractor to see - Chiropractor Belmont

Online Forms

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.

Health History

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

 Download & Print Form (page 1)

 Download & Print Form (page 2)

 

Initial Health Status

If you have HMO insurance, please fill out this form in addition to the 2 pages above for us to process your care.

 Download & Print Form

HIPPA

If you have received chiropractic care elsewhere, or have medical records we will need from another practitioner, please sign this release.

 Download & Print Form

Office Policy

We have made our standard office policy available for you to read.

 Download & Print Form

Free AdobeReader®

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



Dr. Nicole Watson, Dr. David Nichols and Dr. Mark Daly
1601 El Camino Real, Ste 301, Belmont, CA | Phone: (650) 596-5657
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Dr. Nicole Asks some important questions of interest to Belmont residents - Chiropractor Belmont Dr. Nicole Asks...

How come medical doctors don't recommend chiropractic?
That's changing. Years of prejudice and bias are giving way to research showing the benefits of chiropractic care. As more and more Belmont folks seek alternatives to drugs and surgery, more and more medical practitioners are referring their patients to chiropractors.
Could a chiropractor put an end to bedwetting?
If bladder control seems elusive, consider chiropractic. If spinal bones are interfering with nerves that control your child's bladder, plastic sheets, alarms and other methods simply add to the embarrassment. Belmont parents are often amazed (and relieved) that chiropractic can be so helpful. Learn more.