801 South Victoria Avenue

Ventura, CA 93003 US

(805) 644-0460

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Online Forms

Gerckens Chiropractic & Wellness Center offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

  • If you do not already have Adobe Reader® 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!

Forms for ALL new patients:


If involved in a car accident:


If you choose to check one or both of the boxes in the Acknowledgement of Receipt of Notice, the forms associated with them are:


For patients under 18 years of age:



Download the Free Adobe Reader®

New patients receive $15 OFF of nutritional and herbal supplementation.

Office Hours

Our Regular Schedule

Monday:

7:30 am-12:00 pm

2:00 pm-6:00 pm

Tuesday:

2:00 pm-6:00 pm

Wednesday:

7:30 am-12:00 pm

2:00 pm-6:00 pm

Thursday:

8:00 am-12:00 pm

2:00 pm-6:00 pm

Friday:

7:30 am-12:00 pm

2:00 pm-6:00 pm

Saturday:

8:15 am-10:30 am

Sunday:

Closed

Location

Testimonial

  • "Dr. Gerckens is the best chiropractor I have been to. I severely pinched my sciatic nerve 25 years ago. I walked with tremendous pain until I saw a chiropractor.The chiropractor I saw provided some relief, but the problems kept returning. I visited many chiropractors over the years, but my back pain did not permanently end until I visited Dr. Gerckens."
    T.B / Ventura, CA

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