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949-559-7999

New Patient Forms

These health history forms help Dr. Martin understand your condition and current state of health. Dr. Martin offers these forms online so they can be completed in the convenience of your home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • You may fax us your printed and completed form(s) or bring it with you to your appointment.

Adult History Form

Pediatric History Form  (Ages 1-3)

Pediatric History Form (Ages 4-12)

Auto Accident Form


Member Wellness Registration Form - Optional

This form can be filled out to register for access to the member wellness section of our website. You can also sign up for our monthly newsletter to keep up on current health issues and news and events in our office. You can print it out and bring it in to our office or Click Here to register online! The online newsletter sign-up is also on the right. We look forward to making your experience with our office and website more interactive and rewarding!

Download & Print Form


Notice of Privacy Practices

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Dr. Gary Martin, Irvine Chiropractor  
Rettig Chiropractic | Family Chiropractic and Massage |  949-559-7999

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