Health History Forms

Thank you for visiting the website of Northridge Chiropractor, Dr. John Termini and Termini Chiropractic Relief & Wellness - a professional Northridge chiropractic care center. In practice as well online, Northridge California 91324 chiropractor Dr. John Termini practices in the heart of Northridge near Granada Hills, Reseda, Chatsworth, Tarzana, North Hills, Canoga Park, West Hills and Encino.

Termini Chiropractic Relief & Wellness offers our patient form(s) online so they can be completed 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.

New Patient Health History Form

This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Adult Intake Form
Child Intake Form
Stress Test

New Patient Health History Form Children - Required

Download & Print Form


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