FIRST-TIME PATIENT QUESTIONNAIRE
To make your first visit a breeze, we have some suggestions.
We always recommend completing the below questionnaire well in advance of your appointment to get the most out of your first visit.
- Remember to list all the medications, vitamins, and supplements you take and the dosage.
- Please let Dr. Bennett know of any outside treatment you are receiving, such as chiropractic, physical therapy, massage therapy, exercise training, and any medical procedures in the past or future.
The more information you bring with you, the better Dr. Bennett will be able to tailor a plan to your needs, and the quicker you will notice a change in your health.
Plus, bring these items:
- Driver’s License or Identification Card
- If possible, bring all lab reports, X-rays, MRIs, and CT reports done in the last two years
- A detailed list of all medications, vitamins, and supplements you are taking.
Directions:
We are in Fountain Valley, on the border of Huntington Beach at Magnolia and Talbert. We are right at the corner, behind the car wash.
Bennett Acupuncture & Functional Medicine
18046 Magnolia St.
Fountain Valley, CA 92708
Phone: 714-962-5031
Fax: 714-962-5039
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