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Bloomfield Total Health Center

1129 BROAD ST

BLOOMFIELD, NJ 07003 United States

(973) 338-3620

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) 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 and goals, regarding your condition, we can help you with? Let us know!

 

Download & Print Form

New Patient Office Registration Form-Required

This form provides current insurance and billing information that will allow us to verify insurance coverage for you and your families care, at no cost.

Download & Print Form



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New Patient Offer, Ask about our massage and acupuncture specials

Sign-up using the form or call us at 973-338-3620 to take advantage of this exclusive offer.

Location

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Office Hours

Our Regular Schedule

Monday:

9:30 am - 1:00 pm

3:00 pm - 7:00 pm

Tuesday:

Emergencies Only

3:00 pm - 7:00 pm

Wednesday:

9:30 am - 1:00 pm

3:00 pm - 7:00 pm

Thursday:

Emergencies Only

Emergencies Only

Friday:

9:30 am - 1:00 pm

3:00 pm - 7:00 pm

Saturday:

9:00 am - 12:00 pm

Emergencies Only

Sunday:

Closed

Closed