Online Forms

Bloomfield Total Health 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) at (973) 338-4849 or bring it with you to your appointment.

New Patient Office Form (Chiropractic and Physical Therapy)- Required

This lets us know the necessary information needed for your first and subsequent visits including insurance, billing and medical history forms. What questions, concerns and goals, regarding your condition, we can help you with? Let us know!

Download & Print Form

New Patient Office Form (Acupuncture)-Required

This form will provide our licensed acupuncturist with the information needed to create the most effective treatment plan for you. 

PLEASE NOTE: The last two sections of this form are for the acupuncturist to fill. Thank you.

Download & Print Form

New Patient for Massage Therapy

Call us today at (973) 338-3620 to learn about pricing and available times.

Download the Free AdobeReader®