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LIGHTHOUSE CHIROPRACTIC ADULT INTAKE FORM Ages 13 Adult PATIENT INFORMATION Patient Name AddressEmployer/ School ___LAST Preoccupation ___MIDDLE INITIALISM Espouse\'s Name ___City ___ State __ Zip___Spouse\'s

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How to fill out lighthouse chiropractic adult intake

01

Begin by providing your personal information such as name, address, phone number, and email.

02

Fill out the medical history section by indicating any past or current health conditions, injuries, or surgeries.

03

Specify any medications or supplements you are currently taking.

04

Describe the reason for your visit and any symptoms you are experiencing.

05

Sign and date the intake form to acknowledge that the information provided is accurate.

Who needs lighthouse chiropractic adult intake?

01

Individuals who are new patients at Lighthouse Chiropractic and are over the age of 18 need to fill out the adult intake form.

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What is lighthouse chiropractic adult intake?

Lighthouse chiropractic adult intake is a form that new adult patients fill out before their first visit to the chiropractor.

Who is required to file lighthouse chiropractic adult intake?

New adult patients who are visiting the chiropractor for the first time are required to fill out the lighthouse chiropractic adult intake form.

How to fill out lighthouse chiropractic adult intake?

The form can usually be filled out in person at the chiropractor's office or sometimes online through their website.

What is the purpose of lighthouse chiropractic adult intake?

The purpose of the intake form is to collect important information about the patient's health history, current concerns, and contact information.

What information must be reported on lighthouse chiropractic adult intake?

The form typically requires information about medical history, current symptoms, contact details, insurance information, and consent for treatment.

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