Online Forms

PuraVida Wellness Center offers our patient form(s) online so they can be completed in the convenience of your own 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.
  • 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

New Patient Personal Injury Form - Required

This lets us know the history and current state of your accident. What questions, concerns, goals, regarding your injury can we help you with? Let us know!

Download & Print Form



Download the Free Adobe Reader®

Primary Location

Address

2945 S Congress Ave. Suite A,
Palm Springs, FL 33461

Phone

561-388-0909

Monday  

9:00 am - 6:00 pm

Tuesday  

9:00 am - 6:00 pm

Wednesday  

9:00 am - 6:00 pm

Thursday  

9:00 am - 6:00 pm

Friday  

9:00 am - 6:00 pm

Saturday  

Closed

Sunday  

Closed

Contact Us

Fill out the fields below and one of our staff members will contact you as soon as possible.

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Please do not submit any Protected Health Information (PHI).