Blissful Beach

New Patients Only

Complete chiropractic health evaluation with 25 minutes of massage for only $20!
Name*
Email*
Phone Number*

Area CodePhone Number
City
Age
Check all of the symptoms you have experienced in the past 6 months:

HeadachesLeg or Hip PainCarpal Tunnel PainProblems SleepingTingling/ Numbness in Arms or LegsNeck PainArthritisIrritabilityWeight TroubleBack PainShoulders/ Arm PainDizzinessLow Energy/ Fatigue
Other:
Which of the above symptoms concerns you the most?
Concerning that symptom, how long have you experienced it?
Are any of the above selected symptoms the result of a recent auto accident?

YesNo
■ Package is valid for local residents only (living or working in the Orange County area).

■ One package per person. Not available for individuals on federal programs such as Medicare or Medicaid.

■ Package is done over two visits. Package includes a complete chiropractic exam and consultation to be done on the first visit, followed by a report of findings and 25 minutes of therapeutic muscle work on the second visit. Any other services requested may result in additional charges.
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New Patients Only