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Practice Name

Hanna Wellness Center

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Primary Location
30131 Town Center Drive #197
Laguna Niguel, CA 92677
Phone: (949) 389-0400
Fax: 949) 389-0401

Office Hours

DayMorningAfternoon
MondayBy Appt230p-630p
TuesdayBy Appt Only
Wednesday10a-1p3p-630p
ThursdayBy appointment only
Friday10a-1p3p-630p
SaturdayCall for appointment and availability
SundayClosedClosed
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In order to provide you the best possible wellness care, please complete this form

Patient Data

Mailing Address

Current Complaints

Nature of Injury

Insurance Information

*If an auto accident, please provide:

Signatures

Name of the Insured _____________________________________________

I understand and agree that health/accident insurance policies are an arrangement between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment, any fees for professional services rendered to me will be immediately due and payable.

Patient's signature _______________________________________________

Date ____________________

Spouse's or guardian's signature __________________________________

Date ____________________

Medical History

Have you ever:

Family History

Habits

Have you ever suffered from:

Interested in addressing your health concerns from a natural approach? Schedule a complimentary consultation with Dr. Hanna today!

Name: *
Email: *
Phone: *

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Contact

Hanna Wellness Center
30131 Town Center Drive #197
Laguna Niguel, CA 92677
Get Directions
 
  • Phone: (949) 389-0400
  • Fax: 949) 389-0401
  • Email Us

Office Hours

DayMorningAfternoon
MondayBy Appt230p-630p
TuesdayBy Appt Only
Wednesday10a-1p3p-630p
ThursdayBy appointment only
Friday10a-1p3p-630p
SaturdayCall for appointment and availability
SundayClosedClosed
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