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CONFIDENTIAL PATIENT INFORMATION First Name: SS#:Last Name: DOB:Marital Status:/Date: /Sex:# of Children:Height: Zip:City:State:Email:Cell Phone:Emergency Contact:Emergency Relation:How did you hear
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Visit the Active Family Chiropractic website
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Click on the 'Patient Forms' section
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Download the required forms
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Print out the forms and fill them out accurately
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Bring the completed forms to your scheduled appointment at Active Family Chiropractic

Who needs active family chiropractic?

01
Active Family Chiropractic is beneficial for anyone who is seeking non-invasive and drug-free treatment for various musculoskeletal conditions and injuries.
02
This may include individuals experiencing back pain, neck pain, headaches, sports injuries, sciatica, joint pain, and other related conditions.
03
Patients of all ages, from children to seniors, can benefit from the services provided by Active Family Chiropractic.
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Active family chiropractic is a form of chiropractic care that focuses on providing treatment for the whole family to improve overall health and well-being.
Active family chiropractic can be filed by licensed chiropractors who specialize in treating families.
To fill out active family chiropractic, chiropractors must document the treatment provided to each family member and submit the necessary paperwork to insurance companies or other relevant parties.
The purpose of active family chiropractic is to provide holistic care to families in order to promote overall health and well-being.
Information that must be reported on active family chiropractic includes patient demographics, treatment provided, duration of treatment, and any relevant medical history.
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