Vibrant Living Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.

• 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

We ask all patients to complete a new patient health history form. 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!

We are offering two versions of the same form.  Choose the form you are most comfortable working with:

Download & Print Prompted Completion Form

By selecting this form, you will be prompted to complete the form on your computer.  You can print the completed form in order to fax it to us or bring it to your appointment. Please note, your personal history is NOT stored in our system.  You are able to save the completed form on your computer.  Once you close the form, no data is stored on our website.

Download & Print Form  to be completed by hand

This form is designed to be completed manually.  You will not be prompted to complete the form.  

Please bring the completed form with you to your appointment.  You may fax it to: 530-271-5926.

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