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Intake Forms

intake-formsComing for your first appointment? Complete the necessary form below and submit to Recover Wellness. If you do not have an email address, complete the online form and print through your browser window then send to us via  fax or mail.

4105 Timberline Drive
San Jose, CA 95121

Fax: (408) 912-5340

Adult Intake Form

Pediatric Intake Form

Once you have completed your medical history, sign up for your one-time complimentary 30 minute consultation!

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