Confidential Patient Information Form
LA JOLLA CHIROPRACTIC HEALTH CENTER

Chiropractic Medical History and Office Information Forms


In order to save valuable time with the doctor, kindly print-out and complete by hand the following 4 forms prior
to your initial chiropractic office visit.  If you prefer, these forms can be e-mailed or faxed to you upon your
request, and are available in Microsoft Word or Adobe Acrobat formats.  Please phone the office at 858-472-1857
if you have any questions or need assistance.
ChiropracticTreatment Office Policy Forms
Form 1:  Click and Print...
Form 2:  Click and Print...
For your information - About Your Doctor
Form 4:  Click and Print...
Dr. Michael Ackerman helps patients to understand and release the emotional stress patterns underlying their physical problems and disease.  Dr. Michael Ackerman has been in practice
as a chiropractor in La Jolla, California, for 12 years of his 23 years in practice.  Being a La Jolla Chiropractor in San Diego has been extremely rewarding for Dr. Michael Ackerman, and he is
unique among the chiropractic doctors in La Jolla and San Diego in that he has worked with professional athletic teams, such as the New Orleans Saints, the Delta Festival Ballet Company,
as well as collegiate and amateur athletes from most sports backgrounds.  Dr. Michael Ackerman enjoys practicing as a chiropractor by the sea in such a beautiful town as La Jolla,
California, but he also does healing consultations by phone with people from all over the country.
Form 3:  Click and Print...
Body Diagrams To Illustrate Your Condition...
For Back/Leg Pain Click Here   For Neck/Arm Pain Click Here
If you were involved in an auto accident please click here to obtain your proper forms.
Form 5:  Click and Print...
HIPPA Notice and Privacy Forms