Santa Barbara Chiropractor for over 30 years
Patient Intake Forms



All new patients are required to fill out a patient intake form.

This gives us the necessary information to :

  • Process you as a new patient
  • Address your chiropractic and health issues
  • Assess your health  problems related to your structural issues
  • Assist you with insurance claims

You may come to office and fill out forms there. Be sure tho get there 20 minutes before you meet with the doctor.

If you wish to avoid coming in 20 minutes before your appointment, you may download these forms and fill them out. Dr. Girard asks these questions so that she may have a better understanding about your health issues. Be as thorough as possible. Be sure to fill out all sides of the forms so that the doctor may spend all the appointment time assessing and administering treatment.

Please sign the Consent to Treat forms as well. These are required of all patients before they can be treated.

We look forward to seeing you in our office and giving the best care possible.


Click filename below to access file



Dr. Valerie Girard, Santa Barbara Chiropractor

Your Family Chiropractic Health and Wellness Specialist
1725 State Street B, Santa Barbara, CA 93101   (805) 687-1617  (805) 682-1365 fx.

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As one of Santa Barbara's long term chiropractors, Dr. Girard offers brief consultations by phone to determine if she can assist you with your health care needs. She will direct you to other practitioners if she cannot provide you with the health care that best serves you.