Intake Process

Eureka 
blk-phone707-445-8080

1775 Harrison Ave, Eureka, CA 95501

 

Arcata 
blk-phone707-822-2224

655 F st, Arcata, CA 95521

Forms

 

 

Click on the icons below to fill out our new patient forms.

Once they are filled out , you can email the form to  This email address is being protected from spambots. You need JavaScript enabled to view it.  OR you can print the form and bring it to your first visit. 

        Drs Bellinger, Fogg and Buechner are providers for

        Medicare.

        Dr Bellinger is the only Partnership provider.

        Partnership requires a RAF before we can

        schedule an exam.

 

 Andrew Fogg or Anna Nusslock:

 pdfActive-Care-Chiropractic-ONLINE-Intake-forms.pdf

 

 Brian Bellinger or John Buechner:

pdfGrace-Chiropractic-ONLINE-Intake-forms.pdf

 

 

pdfprivacy-practices-2016.pdf

   

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707-445-8080

 

marker1775 Harrison Ave
     Eureka, CA 95501

707-822-2224
marker655F St.
     Arcata, CA 95501