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Online Forms

Ronald J Delaire offers our patient forms online so they can be completed in the convenience of your own home or office, before you even arrive to our chiropractic office.

• 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.

New Patient Health History Form - Required
 
This lets us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!

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 chiropractic office. We look forward to making your experience with our office and website more interactive and rewarding!

Ronald J Delaire
27620 Landau Blvd. Ste. 1
Cathedral City, CA 92234

Phone: 760-320-4123 | Fax: 760-320-0801

Hours:
Monday: 1pm - 5pm
Tuesday: 7:30am - 11am — 1pm - 5pm
Wednesday: 7:30am - 12pm — By Appt.
Thursday: 7:30am - 11am — 1pm - 5pm
Friday: 7:30am - 12pm — By Appt.
Saturday: CLOSED
Sunday: CLOSED

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Follow Us
Ronald J Delaire maintains an active presence on many popular social media websites. Select your favorite website below to stay connected with us.

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