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New Patient Center

Welcome to the Cynthia Smith Chiropractic & Acupuncture & Intuitive Hypnotherapy,  New Patient Center!

We understand that arriving at an office for healing for the first time can feel a little overwhelming. If you've never experienced hypnotherapy or acupuncture  before, you may not know what to expect when you visit our practice for the first time. Meeting new faces, getting oriented to a new space can naturally bring up a bit of uncertainty. 

At Cynthia Smith Chiropractic & Acupuncture & Intuitive Hypnotherapy our intention is to ease that stress from the moment you connect with us. We create a calm, welcoming environment so you can feel supported, grounded, and comfortable throughout your visit.

In this section of the website, you’ll find all the forms you need to fill out of before your appointment. 

We've made everything paperless, but if you find it easier, you may print the necessary forms, fill them out, and bring them with to your first appointment.  If any questions come up, please feel free to contact our our office at anytime (949) 565-5015

Online Hypnotherapy Intake Form

Click Here

Online Hypno Consent Form

Click Here

Fillable Acupuncture Intake

Click Here

Cancellation Policy

Click Here

Consent To Treat A Minor

Click Here

Group Hypnotherapy Media Release

Click Here


Below are our printable versions of our forms.

  • 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.

Acupuncture Chiropractic Intake Form

Download & Print Form


Hypnotherapy/Coaching Intake Form

Download & Print Form Part 1

Download & Print Form Part 2


Consent Form

Download & Print Form


Consent to Treat a Minor Form

Download & Print Form


Facial Acupuncture Intake Form

Download & Print Form


Group Hypnotherapy Media Release

Download & Print Form


Our Location

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Hours

Mon

9:00 am - 6:00 pm

Tue

11:00 am - 6:00 pm

Wed

9:00 am - 4:00 pm

Thu

11:00 am - 6:00 pm

Fri

9:00 am - 5:00 pm

Sat

11:00 am - 3:00 pm

Sunday

By Appointment

Mon
9:00 am - 6:00 pm
Tue
11:00 am - 6:00 pm
Wed
9:00 am - 4:00 pm
Thu
11:00 am - 6:00 pm
Fri
9:00 am - 5:00 pm
Sat
11:00 am - 3:00 pm
Sunday
By Appointment