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Dear Patient:
We need this confidential information answered completely to help us assess your
need for care. If we do not sincerely believe your condition will respond to
chiropractic care, we will not accept you as a patient. Thank you.
These forms are included
for your convenience. Please print and complete them
for your first visit.
To learn more about our policies, please
click here
| New Patient |
If this is your first visit with us for services other than an automotive trauma, personal injury, or workman's compensation,
please print and complete the following form:
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| Biomeridian |
If this is your first Biomeridian evaluation
with us, please print and complete the following
forms:
If this is your first visit with us, we
also ask that you also print and complete
the following form:
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| Automotive Trauma |
If you have sustained a recent injury due to an automotive
accident,
please print and complete the following forms:
If this is your first visit with us, we also ask that you also
print and complete the following form:
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| Personal Injury |
If you have sustained a recent injury
other than one due to an automotive incident,
please print and complete the following form:
If this is your first visit with us, we
also ask that you also print and complete
the following form:
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| Worker's Compensation |
If you have sustained a recent injury
at work, please print and complete the following
forms:
We DO NOT take any worker’s
compensation cases
unless specifically approved by the Doctor.
If this is your first visit with us, we
also ask that you also print and complete
the following form:
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