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Online Forms

Rancho Niguel Chiropractic Center 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.

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!

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American Specialty Health Initial Health Status Form - Required

All American Specialty Health Plan insured patients please fill out this form. Your insurance requires that you fill these out and that we submit them in order for them to approve your treatment.

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Symptom Survey Form - Required

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Insurance Forms - Required for UnitedHealthcare, PacifiCare, and GreatWest

UnitedHealthcare, PacifiCare, and GreatWest Insured Patients please fill out these forms. Your insurance requires that you fill these out and that we submit them in order for them to approve your treatment.

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Dr. David Loaiza 27401 Los Altos Mission Viejo, CA 92691 (949) 831-1932 Serving Mission Viejo, Laguna, and Ladera Ranch

Location

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Office Hours

Our Regular Schedule

Mission Viejo

Monday:

8:30 am-6:00 pm

Tuesday:

10:00 am-5:30 pm

Wednesday:

8:30 am-6:00 pm

Thursday:

10:00 am-5:30 pm

Friday:

8:30 am-6:00 pm

Saturday:

8:30 am-1:00 pm

Sunday:

Closed

Testimonial

  • "The very first time I saw David Loaiza I was impressed that I had one treatment and then he gave me some stretching exercises to do at home to complete my recovery. Over the years he has been effective at addressing a variety of injuries and aches quickly and conservatively. He is knowledgeable, insightful and warm. I recommend him to many friends and colleagues. He is a very good chiropractor."
    Dean B.