Call Us Today!

Santa Ana

(714)-751-2273

Rancho Cucamonga

(909) 377-2570

Riverside

(909) 377-2570

Online Forms

Life & Health 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 AdobeReaderĀ® 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

Or Fill-out our Online Intake Form below.

Online Patient Intake Form

Locations

Find us on the map

Santa Ana Hours

Mon:

9:00 am-1:00 pm

3:00 pm-7:00 pm

Tue:

2:00 pm-7:00 pm

Wed:

9:00 am-1:00 pm

3:00 pm-7:00 pm

Thu:

9:00 am-1:00 pm

3:00 pm-7:00 pm

Fri:

9:00 am-1:00 pm

3:00 pm-6:00 pm

Sat:

appointment only

Sunday:

Closed

Rancho Cucamonga Hours

Mon:

9:00 am-1:00 pm

2:00 pm-6:00 pm

Tue:

9:00 am-1:00 pm

2:00 pm-6:00 pm

Wed:

9:00 am-1:00 pm

2:00 pm-6:00 pm

Thursday:

Closed

Fri:

9:00 am-1:00 pm

2:00 pm-6:00 pm

Saturday:

Closed

Sunday:

Closed