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Dr. Christine CORDIC Dr. Robert RodineCHIROPRACTIC FEE SCHEDULE New Patient Visit $80 Subsequent Visit $40 Extended Visit $50 Acupuncture $47 Active Release Technique $55 Personal Informational: Date

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1. To fill out Dr. Christine Cordick's form, follow these steps:
2. Start by downloading the form from Dr. Cordick's official website or visit her office to get a physical copy.
3. Read the instructions at the beginning of the form carefully. It will provide guidance on how to fill out each section.
4. Begin by inputting your personal information, such as your full name, date of birth, and contact details.
5. Move on to the medical history section. Here, you will be asked to provide information about any previous illnesses, surgeries, or medical conditions.
6. Fill out the current medications you are taking, including the name of the medication, dosage, and frequency.
7. If applicable, provide details about any allergies you have, especially if they are related to medications or specific substances.
8. In the next section, you may be required to provide information about your insurance coverage.
9. Once you have completed all the required sections, review your answers to ensure accuracy and completeness.
10. Sign and date the form at the designated area to certify that the information provided is accurate to the best of your knowledge.
11. Submit the filled-out form either by mailing it to Dr. Christine Cordick's office or by personally delivering it.
12. Remember, it's crucial to be honest and thorough when filling out the form to ensure Dr. Cordick has all the necessary information to provide proper medical care.

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