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CARDINAL CHIROPRACTIC 13648 Orchard Parkway, Ste 800, Westminster, CO 80023 Today's Date / / (303) 9537888info cardinalfamilychiro. Pediatric HISTORY FORMER#: PATIENT DEMOGRAPHICS Child's Name Date
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To fill out the Cardinal Chiropractic form, follow these steps:
02
Begin by entering your personal information such as your name, address, phone number, and email address.
03
Provide your insurance information, including the name of your insurance company and your policy number.
04
Specify your primary reason for seeking chiropractic treatment. You may also mention any specific symptoms or medical conditions you would like the chiropractor to address.
05
Indicate any previous chiropractic care you have received, including the names of chiropractors and the duration of treatment.
06
Answer the questionnaire regarding your current health status, including any pain or discomfort you may be experiencing.
07
Provide a brief medical history, mentioning any surgeries, injuries, or chronic illnesses you have had.
08
Sign and date the form, indicating that the information provided is accurate and complete.
09
Once you have filled out the form, submit it to Cardinal Chiropractic either in person or through their preferred submission method.

Who needs cardinal chiropractic?

01
Cardinal Chiropractic is beneficial for individuals who:
02
- Experience chronic pain or discomfort in their musculoskeletal system.
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- Have undergone injuries, such as strains, sprains, or fractures, that require rehabilitation.
04
- Seek non-invasive and drug-free treatment options for their health concerns.
05
- Want to improve their overall physical well-being and flexibility.
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- Are looking for alternative approaches to manage stress and promote relaxation.
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- Are interested in maintaining optimal spinal health and preventing future injuries.
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- Wish to enhance their athletic performance or recover from sports-related injuries.
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- Are seeking personalized and holistic healthcare from licensed chiropractors.
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Cardinal Chiropractic is a healthcare practice that focuses on diagnosing and treating musculoskeletal disorders.
Cardinal Chiropractic practitioners are required to file their practice information with the appropriate regulatory agencies.
To fill out Cardinal Chiropractic forms, practitioners must provide details about their practice, patient treatments, and any medications prescribed.
The purpose of Cardinal Chiropractic is to help patients alleviate pain, improve mobility, and enhance overall wellness through non-invasive treatments.
Information such as patient diagnosis, treatment plans, progress notes, and any adverse reactions must be reported on Cardinal Chiropractic forms.
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