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Practice Name

Lynott Chiropractic & Acupuncture

Primary Location
5512 Britton Dr. Ste 100
Long Beach, CA 90815
Phone: 562-594-6644
Fax: 562-594-6114

Office Hours

Day
Monday8:00-1:003:00-6:00
TuesdayClosedClosed
Wednesday8:00-1:003:00-6:00
ThursdayClosed1:00-6:00
Friday8:00-1:003:00-6:00
Saturday9:00-1:00Closed
SundayClosedClosed
Main Content

In order to provide you the best possible wellness care, please complete this form

Patient Data

Mailing Address

Current Complaints

Nature of Injury

Insurance Information

*If an auto accident, please provide:

Signatures

Name of the Insured _____________________________________________

I understand and agree that health/accident insurance policies are an arrangement between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment, any fees for professional services rendered to me will be immediately due and payable.

Patient's signature _______________________________________________

Date ____________________

Spouse's or guardian's signature __________________________________

Date ____________________

Medical History

Have you ever:

Family History

Habits

Have you ever suffered from:

Office Hours

Day
Monday8:00-1:003:00-6:00
TuesdayClosedClosed
Wednesday8:00-1:003:00-6:00
ThursdayClosed1:00-6:00
Friday8:00-1:003:00-6:00
Saturday9:00-1:00Closed
SundayClosedClosed

Online Forms

Lynott Chiropractic & Acupuncture offers our patient form(s) online so they can be completed it in the convenience of your own home or office.
Download Online Forms Here

Make Appointment

We will do our best to accommodate your busy schedule. Request an appointment today!

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Services

We strive to provide complete care for our patients. Learn more about all the services we provide.

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Contact

Lynott Chiropractic & Acupuncture
5512 Britton Dr. Ste 100
Long Beach, CA 90815
Get Directions
 
  • Phone: 562-594-6644
  • Fax: 562-594-6114
  • Email Us
From:  To:  Get Directions
Driving Directions: Reverse Directions Print Directions

Office Hours

Day
Monday8:00-1:003:00-6:00
TuesdayClosedClosed
Wednesday8:00-1:003:00-6:00
ThursdayClosed1:00-6:00
Friday8:00-1:003:00-6:00
Saturday9:00-1:00Closed
SundayClosedClosed
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