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New Patient Forms

If you are a first-time patient at New Life we recommend that you fill out your patient information packet prior to your first appointment. You can help speed up your first appointment by downloading/printing one of the files below depending on your insurance coverage or payment method. If you have Private Insurance, Workers Compensation, Personal Injury or you are a Cash patient select the �Private Insurance Patient� link below. If you have Medicare as your primary insurance select the �Medicare Patient� link below. Once you have filled out the forms packet, please bring it along with your doctor�s prescription/referral and insurance card when you arrive for your scheduled evaluation. You can also fax this information to (714) 375-7563 or mail it to 17122 Beach blvd., Suite 101 Huntington Beach, CA 92647. Call our office at (714) 848-7191 if you have any questions.

Please select the type of new patient forms you would like to download by clicking on the appropriate link below.

   

Private Insurance Patient

Medicare Patient



Providing Quality Care and Excellent Customer Service to Orange County, CA Since 1990. 

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17122 Beach blvd., Suite 101 Huntington Beach, CA 92647
(714) 848-7191 Fax (714) 375-7563

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