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EAST LAKE CHIROPRACTIC AND MASSAGE CENTER, PATIENT REGISTRATION Patient: LASTFIRSTDate of birth Today's Date Male FemaleMIDDLEAddress: City, State, Zip: Social Security #: EMAIL: Phone # () Work phone

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What is eastlake chiropractic and massage?

Eastlake Chiropractic and Massage is a health and wellness center that provides chiropractic care and therapeutic massage services to help patients alleviate pain, improve mobility, and enhance overall well-being.

Who is required to file eastlake chiropractic and massage?

Individuals seeking treatment at Eastlake Chiropractic and Massage may need to file for insurance reimbursement, while the clinic must file claims with insurance companies for services rendered.

How to fill out eastlake chiropractic and massage?

To fill out forms at Eastlake Chiropractic and Massage, patients need to provide personal information, insurance details, medical history, and sign consent forms for treatment.

What is the purpose of eastlake chiropractic and massage?

The purpose of Eastlake Chiropractic and Massage is to provide holistic care aimed at relieving pain, promoting healing, and fostering a healthy lifestyle through chiropractic adjustments and massage therapy.

What information must be reported on eastlake chiropractic and massage?

Patients must report personal information, insurance details, medical history, and any current health conditions or medications they are taking when accessing services at Eastlake Chiropractic and Massage.

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