Request An Appointment
USE THE FORM OR CALL 323-665-1985

 


 

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).

 


 

Appointment

  • Do not fill this form out if you're a solicitor.
  • How Can We Help?

  • :
  • This field is for validation purposes and should be left unchanged.

 


 

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 everacuwellness@gmail.com or print it and bring it with you to your appointment.

 

Click For Intake Form

 

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!