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Duben Holistic Chiropractic Center 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.

  • 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.
  • 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!

Download & Print Form

Consent to Treat a Minor

Consent form for Doctor Duben to treat a minor.

Download & Print Form

Missed or Cancelled Appointment Form

Missed or cancelled appointment agreement 

Download & Print 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 chiropractic office. You can print the form out and bring it in to our office during your next visit with our chiropractor, 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

Download the Free AdobeReader®

Exclusive Offer

New Patients Get a Full Chiropractic Exam for Just $35*

*Offer Valued at $175. Sign-up using the form below or call us at (805) 494-1339 to take advantage of this exclusive offer.

THIS ---->https://docdubencom.chiromatrixbase.com/online-forms.html

Office Hours

Monday9am - 6pm3pm - 6pm
Tuesday9am - 2pmClosed
Wednesday9am - 6pm3pm - 6pm
Thursday9am - 6pm3pm - 6pm
Friday9am - 6pm3pm - 6pm
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9am - 6pm 9am - 2pm 9am - 6pm 9am - 6pm 9am - 6pm Closed Closed
3pm - 6pm Closed 3pm - 6pm 3pm - 6pm 3pm - 6pm Closed Closed


I would recommend Dr. Duben to my friends and family and have done just that! I have been coming to see Dr. Duben for about 4 years. I initially came because i popped a rib out of my chest and have been a believer ever since! His work with NET and natural holistic vitamins are only a plus! His staff is great and friendly! I always look forward to my appointments!

Kathy N.
Thousand Oaks, CA

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