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ONLINE FORMS

Exceptional Wellness Center offers our patient form(s) online so they can be completed 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 lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

Download & Print Form

Allergy Re-treatment Acknowledgement
Dr. Phillips Credit Card Authorization Form
EWC Plan Sheet
Face Sheet
Gloria Phillips Office Policies and Financial Agreement
Informed Consent for Chiro
Informed Consent for Exam
Notice of Privacy Practices

Download the Free Adobe Reader®

2001 S. Barrington Avenue Suite 316 

West Los Angeles, CA 90025

E-mail: exceptionalwellness316@gmail.com 

Phone: 310 473 2020 |  Fax: 310 473 2588

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