Online Forms

Gallardo Chiropractic offers our patient forms online so you can take your time and fill them out in the comfort of your home or office.

  • ATTENTION! You will need Adobe Reader® installed. Click here to download if you don’t already have it installed.
  • Download and print the forms, fill them out, and bring them with you to your appointment.
  • PLEASE USE BLACK INK ONLY!
  • Allow several minutes for our staff to process your forms when you arrive at your visit.

ALL FORMS ARE REQUIRED TO BE FILLED OUT AND SIGNED BY THE INDIVIDUAL RECEIVING TREATMENT

PLEASE USE BLACK INK ONLY!
1) New Patient Information Form

2) New Patient Intake Form

3) Current Symptoms Form

4) Informed Consent for Chiropractic Treatment

5) HIPPA Form

 

contact info

Phone

(408) 258-3200

Office Address

135 N Jackson Ave #201, San Jose, CA 95116

Office Hours

Monday       8 a.m. – noon   3:00 p.m. – 6 p.m.

Tuesday       8 a.m. – noon

Wednesday  8 a.m. – noon   3:00 p.m. – 6 p.m.

Thursday      8 a.m. – noon

Friday            8 a.m. – noon   3:00 p.m. – 6 p.m.