New Patient Paperwork

  • Adams Chiro New Patient Paperwork 2020

  • New Patient Info Packets

  • Patient Demographics

  • Symptom Survey

  • Symptom, Health History and Pain Assesment cont.

  • Health Care Privacy Notice Assignment of Benefits

  • Consent to treat a minor

  • Patient Privacy Disclosure

  • Healthcare Privacy Notice

  • Health Care Privacy Notice cont.

  • Financial Policy Agreement

  • Appointment Reservation Agreement

  • Authorization To Keep Credit Card on File Optional

Please call 972-596-1611

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Adams Health Center

Been coming for years. I really feel better after an adjustment.

— Linny M.