Request An Appointment
USE THE FORM OR CALL (323) 391-7616
We’re so excited for you to begin your journey of healing.
Requested dates are not guaranteed. We’ll follow up with a phone call to confirm times for your consultation and treatment.
Please do not submit any Protected Health Information (PHI).
Evergreen Wellness Center, Inc. offers our patient form(s) online so they can be completed in the convenience of your own home or office.
- Download the necessary form, print it out and fill in the required information.
- Email your completed form(s) to firstname.lastname@example.org or print it and bring it with you to your appointment.
New Patient Intake 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!