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CONFIDENTIAL HEALTH INFORMATION Timothy D. Henderson DC Chiropractor 40 County Road 123 Gainesville Texas 76240 www. Endocrine Thyroid issues i. Genitourinary Immune Hypoglycemia Kidney stones Infertility Bedwetting Frequent Prostate issues Erectile dysfunction j. HendersonChiropractic.Com Please allow our staff to photocopy your driver s license and insurance details. What would be the most significant thing that you could do to improve your health Patient or Guardian s signature Date...

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Henderson DC stands for Henderson Discretionary Compensation, which is a form used for reporting discretionary compensation payments to employees.

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