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Fairway Chiropractic & Rehab - Dr. Nimesh Ladhawala 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 form(s) or bring it with you to your appointment.


Forms

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!

New Patient Health History

New Patient Health History 2

Auto Accidents

Workers' Compensation

 


 

Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form


Download the Free AdobeReader®

Sign up using the form or call 909-598-2304 to make your appointment.

Office Hours

Day
Monday9am - 1pm3pm - 7pm
TuesdayClosed3pm - 7pm
Wednesday9am - 1pm3pm - 7pm
ThursdayClosed3pm - 7pm
Friday9m - 1pm3pm - 7pm
Saturday9am - 1pmClosed
SundayClosedClosed
Day
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9am - 1pm Closed 9am - 1pm Closed 9m - 1pm 9am - 1pm Closed
3pm - 7pm 3pm - 7pm 3pm - 7pm 3pm - 7pm 3pm - 7pm Closed Closed