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WELCOME! Today s Date: / / Your Name: Male Female What do you prefer to be called/Nickname: Date of Birth: / / Age: SS #: Driver's License #: State Issued: Marital Status: Single Married Divorced
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How to Fill Out Welcome - Garden Chiropractic:
01
Start by entering your personal information, including your full name, contact details, and any medical history or conditions that may be relevant to your chiropractic treatment.
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Fill in the reason for your visit to Welcome - Garden Chiropractic. Indicate whether you are seeking treatment for a specific condition, general wellness, or any other relevant reason.
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Specify the date and time of your appointment. If you haven't scheduled one yet, you can leave this section blank or indicate your preferred availability.
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Review and sign any consent forms or agreements provided by the chiropractic clinic. These may include information about privacy policies, payment terms, and treatment plans.
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Anyone interested in maintaining overall health and wellness through regular chiropractic adjustments and aligning their spine for optimal function.
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