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WWW.diversified health.ca 1063 Fort Street Victoria, BC V8V 3K5 pH. (250) 3820018 Fax (250) 3820083PATIENT INTAKE:BC Health Care Card Name Date of Birth (MM/DD/YYY) Address Unit & Street cumbersome
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To fill out the form for Fort Street Family Chiropractic, follow these steps:
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Start by downloading the form from their official website or obtain a physical copy from their clinic.
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Read the instructions carefully to understand the information required.
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Begin by providing your personal details such as name, address, phone number, and email.
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Fill in your medical history accurately, including any past injuries, surgeries, or chronic conditions.
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If you have any current symptoms, describe them in detail to help the chiropractor understand your condition better.
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Submit the completed form to Fort Street Family Chiropractic either in person or via email/fax as mentioned in the instructions.

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Fort Street Family Chiropractic is a healthcare facility that provides chiropractic services to promote health and wellness, focusing on spinal health and musculoskeletal issues.
Individuals seeking chiropractic care or reimbursement for chiropractic services may be required to file documents associated with Fort Street Family Chiropractic.
To fill out the documentation for Fort Street Family Chiropractic, patients should provide their personal information, details of the chiropractic services received, and any relevant insurance information.
The purpose of Fort Street Family Chiropractic is to provide chiropractic care to improve patients' health, relieve pain, and enhance overall well-being.
The information that must be reported includes patient name, date of service, specific treatments provided, and billing information related to insurance claims.
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