New Patient Forms

Save Time

Complete Your Forms Before Your Visit

At Urteaga Chiropractic, we value your time and want to make your first visit as smooth and stress-free as possible. To streamline your check-in process, we offer convenient downloadable and online form options for new patients, personal injury cases, and sports physicals.

Please complete the forms that apply to your visit type below.

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Note: Do not submit any Protected Health Information (PHI) via unsecured email. All online form submissions are securely processed.

Patient Intake Form

General intake form for new chiropractic patients at all locations.

Personal Injury Patients

Required for patients receiving treatment due to a car accident, workplace injury, or other personal injury case.

Sports Physicals Flyer

Required for school or athletic sports clearance. Bring this form completed to your appointment.

Questions? We’re Here to Help.

Not sure which form you need? Call the clinic nearest you and we’ll guide you through the process:

Whittier Office

Cerritos Office

Irwindale Office

Orange Office