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Practice Name

Village Wellness Chiropractic

Primary Location
1826 S Elena Ave #A
Redondo Beach, CA 90277
Phone: 310-373-3500
Fax: 310-373-3503

Office Hours

DayMorningAfternoon
Monday8:00am6:00pm
Tuesday8:00am6:00pm
Wednesday8:00am6:00pm
Thursday8:00am6:00pm
Friday8:00am6:00pm
SaturdayBy Appt.
SundayClosed
Main Content

Village Wellness Chiropractic offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic 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.

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


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 chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor, 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


Chemical Balance Questionnaire

Speed of healing is determined by chemical balance in the body. Chemical Balance is
determined, in large, by what you eat. Please fill out this form and indicate the amounts and frequencies you partake in the items listed.

Download & Print Form


Informed Consent Form for Chiropractic Care

Chiropractic care, like all forms of health care, while offering considerable benefit may also provide some level of risk. This level of risk is most often very minimal, yet in rare cases injury has been associated with chiropractic care. Please fill out this form to indicate that you acknowledge these risks and accept them prior to treatment.

Download & Print Form


Patient Health Information Consent Form

We want you to know how your Patient Health Information (PHI) is going to be used in this office and your rights concerning those records. Before we will begin any health care operations we must require you to read and sign this consent form stating that you understand and agree with how your records will be used.

Download & Print Form


HIPAA Notice

Download & Print Form


Download the Free AdobeReader®

Exclusive Offer

New Patients Receive a Free Consultation.

Sign-up using the form or call us at 310-373-3500 to take advantage of this exclusive offer.

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Contact

Village Wellness Chiropractic
1826 S Elena Ave #A
Redondo Beach, CA 90277
Get Directions
 
  • Phone: 310-373-3500
  • Fax: 310-373-3503
  • Email Us

Office Hours

DayMorningAfternoon
Monday8:00am6:00pm
Tuesday8:00am6:00pm
Wednesday8:00am6:00pm
Thursday8:00am6:00pm
Friday8:00am6:00pm
SaturdayBy Appt.
SundayClosed
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