Online Forms

Clean Living Health Clinic offers our patient form(s) online so you can complete it 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 (White) - Required

This let's us know the history and current state of your health. What questions, concerns, goals, regarding wellness can we help you with? Let us know!


Symptoms Survey Form

Download & Print Forms


Class Hour Preparation Comparison

Download & Print Forms

Locations

Find us on the map

Office Hours

Our Regular Schedule

Monday

*9:00am - 12:00pm

*2:00pm - 4:00pm

Tuesday

8:00 am - 12:00 pm

1:30 pm - 5:00 pm

Wednesday

8:00 am - 12:00 pm

1:30 pm - 5:00 pm

Thursday

8:00 am - 12:00 pm

Friday

*9:00am - 12:00pm

*2:00pm - 5:00pm

Saturday

Closed

Sunday

By Appointment

Closed

Monday
*9:00am - 12:00pm *2:00pm - 4:00pm
Tuesday
8:00 am - 12:00 pm 1:30 pm - 5:00 pm
Wednesday
8:00 am - 12:00 pm 1:30 pm - 5:00 pm
Thursday
8:00 am - 12:00 pm
Friday
*9:00am - 12:00pm *2:00pm - 5:00pm
Saturday
Closed
Sunday
By Appointment Closed

*Only in Bloomfield this day

Call Us: (765) 530-8117 Hagerstown (765) 541-9450 Bloomfield