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Online Forms - Performance Health Medical Group

* Print out forms, complete and bring them with you to your appointment. Do not fax or e-mail them to our office.

 

Online Forms - Performance Health Medical Group

Performance Health Medical Group offers our patient form(s) online so they can be completed 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.

New Patient Health History Form - Required For All Patients

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!

Download & Print Form

* You will be asked to review and sign additional consents in the office


ACCIDENT HISTORY QUESTIONNAIRE

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!

Download & Print Form


Back Pain OSWESTRY DISABILITY INDEX 2.0

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!

Download & Print Form


Confidential Patient Information

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!

Download & Print Form


DOCTOR'S FIRST REPORT
OF OCCUPATIONAL INJURY OR ILLNESS

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!

Download & Print Form


Federal First Report of Injury

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!

Download & Print Form


HEADACHE DISABILITY INDEX

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!

Download & Print Form


The Neck Disability Index

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!

Download & Print Form


PAIN DISABILITY QUESTIONNAIRE

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!

Download & Print Form


PRIMARY TREATING PHYSICIAN'S PROGRESS REPORT (PR-2)

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!

Download & Print Form


QUADRUPLE VISUAL ANALOGUE SCALE

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!

Download & Print Form


Treatment Authorization

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!

Download & Print Form


Website Member 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. 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


Contact Us

25431 Cabot Rd., Ste 118
Laguna Hills, CA 92656

Office Hours

Monday - Friday:

8:00am - 1:00pm

3:00pm - 7:00pm

Phone: 949-362-8877

Fax: 949-362-9230

Drug Screenings:

9:00am - 12:00pm

3:00pm - 6:00pm

TESTIMONIALS
I have been coming to Performance Health Medical Group for 6-7 years and I had my foot surgery and all the doctor's took great care of me. I got better in no time. I also hurt my neck and came in for the injury and the doctor's and staff were so helpful. I'm getting better and very happy with the...

Harwinder R.