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Pinks family chiropracticADULT INTAKE FORM Date: PERSONAL INFORMATION First Name: M.I.: Last Name: Preferred Name: Social Security Number: Address: City: State: Zip: Email: Cell Phone: () Alternate
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Pinkus Family Vortala is a financial form that must be filed to report family income and expenses.
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Information such as income sources, expenses, deductions, and family members must be reported on Pinkus Family Vortala.
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