Dr. Leilani Bettencourt

Westwood Family Chiropractic 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 forms (408-385-1853) 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!

Adult New Patient Form

Click to Download and Print Form

Pediatric New Patient Form

Click to Download and Print Form

Office Policy Form

Click to Download and Print Form

Informed Consent Form

Click to Download and Print Form

HIPPA Form

Click to Download and Print Form

Covid-19 Informed Consent To Treat Form

Click to Download and Print Form



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Office Hours

Our Regular Schedule

Monday

By Appointment

By Appointment

Tuesday

8:00am-12:00pm

3:00pm-6:00pm

Wednesday

Closed

Closed

Thursday

Closed

2:30pm-6:30pm

Friday

8:00am-12:30pm

Closed

Saturday

Closed

Closed

Sunday

Closed

Closed

Monday
By Appointment By Appointment
Tuesday
8:00am-12:00pm 3:00pm-6:00pm
Wednesday
Closed Closed
Thursday
Closed 2:30pm-6:30pm
Friday
8:00am-12:30pm Closed
Saturday
Closed Closed
Sunday
Closed Closed

Location

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