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Practice Name

Ponte Vedra Wellness Center

Social Media
Primary Location
100 Corridor Rd. S. Suite 220
Ponte Vedra Beach, FL 32082
Phone: 904-273-2691
Fax: 904-273-4607

Office Hours

Day
Monday8:30am-1:30pm3:00pm-6:00pm
Tuesday2:00pm6:30pm
Wednesday9:00am6:00pm
Thursday9:00am1:00pm
Friday8:00am5:00pm
Saturday9:00am11:00am
SundayClosed-Emergencies OnlyClosed-Emergencies Only
Main Content

Ponte Vedra Wellness Center 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 - 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!

Download & Print Form

In order to provide you the best possible wellness care, please complete this form

Patient Data

Mailing Address

Current Complaints

Nature of Injury

Insurance Information

*If an auto accident, please provide:

Signatures

Name of the Insured _____________________________________________

I understand and agree that health/accident insurance policies are an arrangement between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment, any fees for professional services rendered to me will be immediately due and payable.

Patient's signature _______________________________________________

Date ____________________

Spouse's or guardian's signature __________________________________

Date ____________________

Medical History

Have you ever:

Family History

Habits

Have you ever suffered from:


Auto Accidents Form - Optional

Download & Print Form


Workers Comp Form - Optional

­ 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 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



Download the Free AdobeReader®

Special Offer

Exclusive Offer

Take advantage of this month's "Condition of the Week" Special Offers! 

Elbow/Shoulder - Jan 8-27
Sciatica - Jan 15 - Feb 3
Accident/Injury - Jan 22 - Feb 10
Allergies - Jan 29 - Feb 17

 

Contact Us Using the Form Below:

 

Name: *
Email: *
Phone: *


3D Spine Simulator

 
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 3D Spine Simulator

Success Stories

I would recommend Dr. Hamer and Ponte Vedra Wellness Center to my family and friends they provide the best therapeutic care for chiropractic needs, additionally they have a friendly and caring professional staff that supports Dr. Hamer's outstanding health care services.

Veronica V. -
Ponte Vedra Beach, FL


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Make Appointment

We will do our best to accommodate your busy schedule. Request an appointment today!

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Services

We strive to provide complete care for our patients. Learn more about all the services we provide.

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Contact

Ponte Vedra Wellness Center
100 Corridor Rd. S. Suite 220
Ponte Vedra Beach, FL 32082
Get Directions
 
  • Phone: 904-273-2691
  • Fax: 904-273-4607
  • Email Us
From:  To:  Get Directions
Driving Directions: Reverse Directions Print Directions

Office Hours

Day
Monday8:30am-1:30pm3:00pm-6:00pm
Tuesday2:00pm6:30pm
Wednesday9:00am6:00pm
Thursday9:00am1:00pm
Friday8:00am5:00pm
Saturday9:00am11:00am
SundayClosed-Emergencies OnlyClosed-Emergencies Only
Newsletter

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Community Content
Member Wellness