Request an Appointment

Bergman Family Chiropractic
18582 Beach Blvd. #22
Huntington Beach, CA 92648
714-962-5891
info@bergmanchiropractic.com
*Indicates a Required Field

Please view our office hours and then fill in the following form to request an appointment. You will receive a confirmation call to verify, before any appointment is scheduled.

*First Name
*Last Name
*Phone
format: XXX-XXX-XXXX
*Email Address


Date and Hour for Requested Appointment

*Select Hour *AM/PM

*Please tell us if you are a current patient, or are requesting to become a new patient.
I am a current patient at your office
I am looking to make an appointment to become a new patient


Optional Short Comments or Message

For verification purposes, please type in the numbers and letters that you see below then press the Send Request button.

NOTE: You do not have a scheduled appointment until we can call you and verify this appointment request.

               

Bergman Family Chiropractic's

Adjusting Hours

Monday/Wednesday/Thursday
 7-11, 2-6
 Tuesday
2-2:45, 5-5:30
Please Call to Schedule an Appointment
(714) 962-5891   
 
 Come to our Half Hour to Health Workshop
 E very Tuesday Night at 6-6:30