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Please print off the following form. All pages in the form are required to receive treatment at Scott Family Chiropractic. This includes: General information about yourself  (or dependant) and your current condition, HIPAA privacy policy also serving as a consent to treatment in our office, a financial policy (regardless of health insurance coverage), and our 24 hour cancellation policy. If you have any questions about any part of the form, please contact our office at (970)663-2225.

 

Click to download the form:

Chiropractic Intake

 

Your privacy is important to us. All information received in the above forms and through other communications is subject to our Patient Privacy Policy.

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