Online Forms

Dr. Yajima and his staff offer patient form(s) online so they can be completed in the convenience of your own home or office.

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Download the necessary form(s), print and fill it in with the required information.
Fax us your printed and completed form(s) or bring it with you to your appointment.

New Patient Registration & Health History Form - Required

This lets us know the history and current state of your health. What questions, concerns, and/or goals regarding wellness can we help you with? Let us know! Click the file below to download and print form.

Office Policy Form - Required

Please take a moment to review our office policies designed to enhance your doctor/patient relationship. Click the form below to download and print form.

You will also be asked to review and sign forms related to Informed Consent, Private Practices Notice, and Assignment of Benefits at your appointment. You are welcome to also print and complete these at your convenience which will expedite the new patient intake process during your first visit. The doctor will fill out the Pain Drawing based on your initial examination.