Important Instructions! Read before you start! Instrucciones importantes! ¡Lea antes de comenzar!

If you are a patient of the following type you will need to complete and sign the form numbers listed below.
***NOTE: click on the numbers to open the forms in a new browser window and this page will stay open behind them!

PHYSICAL THERAPY:
Physical Therapy patients - please complete the forms associated with the your insurance plans below!

Workers Compensation: Forms: 1, 2, 3, 4 & 7

Personal Injury: Forms: 1, 2, 3, 4, 7 & 8

Private Insurance/Cash Patients: Forms: 1, 2, 3, 4, 5 & 7

Medicare Patients: Forms: 1, 2, 3, 4, 6 & 7

ACUPUNCTURE (LYG):
Acupuncture patients - please complete the forms associated with the your insurance plans below!
***NOTE: click on the numbers to open the forms in a new browser window and this page will stay open behind them!

Workers Compensation: Forms: 1, 2, 3, 4 & 5

Personal Injury: Forms: 1, 2, 3, 4, 5 & 6

Private Insurance/Cash Patients: Forms: 1, 2, 3, 4, 5 & 7

MAIN OFFICE

1809 E. Dyer Rd. #313
Santa Ana CA 92705

Fax (949) 975-0070

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No Referral Needed

MAIN OFFICE

1809 E. Dyer Rd. #313
Santa Ana CA 92705