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Online Forms

New Patient Health History Form (Required)

This let's us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!
Download PDF 
If you were involved in an Accident use this form
Download PDF 

Smith Upper Cervical Chiropractic offers our patient form(s) online so you can complete it in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

WE CARE. WE LISTEN. WE GET RESULTS.

Break free from pain, so you can get back to doing the things you love.
Enjoy a brighter future, and be healthier than you ever thought possible!
Request a Consultation
Dr. Smith is an Upper Cervical Chiropractor with experience helping serious cases get well in his Huntington Beach Chiropractic office since 2000. If you have been on the referral merry-go-round with no results you owe it to yourself to give Dr. Smith's unique approach a try. We work to restore your health naturally and guide you in a personalized approach to overall wellness through Blair Upper Cervical Chiropractic Spinal Health Care, exercise, good nutrition and stress management.
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Office Hours

Monday & Thursday
9:00 am - 1:00pm | 3:00pm - 5:00pm
Wednesday
Closed
Tuesday & Friday
9:00 am - 1:00pm | 3:00pm - 4:00pm
Saturday
9:00am - 11:00am
Sunday
Closed

Monday & Thursday
9:00 am - 1:00pm | 3:00pm - 6:00pm

Wednesday 
Closed

Tuesday & Friday
9:00 am - 1:00pm | 3:00pm - 4:00pm

Saturday
9:00am - 11:00am

Sunday
Closed

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