Appointments &  Medical history

Patient Portal

New Patient Intake Forms (ages 16+)

Please fill out this confidential health history form as completely as you can. The more information you provide us, the better we will be able to help you. 

NEW PATIENT INTAKE FORM

METABOLIC ASSESSMENT FORM

Naturopathic Intake Forms

Please fill out this form if you are scheduled for a visit with our naturopathic doctors and bring it with you to your first appointment.

NEW PATIENT INTAKE FORM

NUTRITIONAL ASSESSMENT FORM

METABOLIC ASSESSMENT FORM

Pediatric Intake Forms (newborns – 15 years)

Please fill out this confidential heath history form if the patient in question is a newborn or under 15 years of age and bring it with you for your first appointment.

NEW PATIENT INTAKE FORM

Acupuncture Intake Forms

Please fill out this form if you are scheduled for an acupuncture session and bring them with you to your first appointment.

NEW PATIENT INTAKE FORM

Esthetics Intake Forms

Please fill out this form if you are scheduled for an esthetics session and bring it with you to your first appointment.

NEW PATIENT INTAKE FORM

Contact Our Office

Address

Cohn Health Institute
3151 Airway Avenue, Suite U-3
Costa Mesa, CA 92626

Hours

Monday 9:00 am – 6:30 pm
Tuesday 9:00 am – 2:30 pm
Wednesday 9:00 am – 6:30 pm
Thursday 9:00 am – 6:30 pm
Friday 8:30 am – 3:00 pm
Saturday 9:00 am – 2:00 pm
Sunday Closed 

Call Us