Teresa Yin, D.C. | Chiropractor, Industrial Medical Examiner, Qualified Medical Evaluator

  • Home
  • Contact
  • Meet our Team
  • Our Policies
    • Patient Forms
  • About Chiropractic
    • What is Chiropractic?
    • How Chiropractic Can Help
    • Stages of Care
  • Services
    • Chiropractic Adjustment
    • Graston Technique
    • Soft Tissue Procedures
    • Physiotherapy
    • Nutritional Management
    • Exercise Rehabilitation
    • Massage Therapy
    • Kinesio Taping
    • Orthotic Devices
    • Ergonomic Evaluations
    • Products
  • FAQs
    • FAQs – General Information
    • FAQs – Treatment
  • Resources

Patient Forms

To save time, you may print these forms, complete them before your appointment, and bring them with you.

Patient Registration Form

Initial Problem Report

Patient Health History

Notice of Confidentiality and Privacy Practices

Informed Consent for Chiropractic Treatment and Care

Privacy Practices Acknowledgement

Consent for Use and Disclosure of Health Information

Our Policies

Patient Forms

COVID-19 Update
39210 State St. Suite 110  •  Fremont, CA 94538
Phone: (510) 793-6302  •  Map & Directions
Read our reviews on YelpConnect with us on Facebook
©2008-2017 Dr. Teresa Yin | Privacy | Terms of Use website design by collective discovery