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The Spinal Decompression and Chiropractic Center ASSIGNMENT OF BENEFITS & DIRECT PAYMENT TO DOCTOR Re: Patients Name: Patient/Insureds Employer: Patient/Insureds SSN#/ID#: Date of Birth: Claim/Group
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Form spinal decompression is a medical procedure used to relieve pressure on the spine.
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Form spinal decompression can be filled out by providing personal information and details about the therapy.
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The purpose of form spinal decompression is to track and report on patient progress during therapy.
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Information such as patient name, date of therapy, therapist name, and therapy progress must be reported.
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