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Chiropractic Case History/Patient Information Date:___Patient #:___Doctor:___Name:___ Social Security #:___Home Phone: ___ Address:___City:___ State:___ Zip:___ Email address:___ Fax #: ___ Cell Phone:___
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01
Step 1: Start by entering your personal information such as your name, address, and contact details.
02
Step 2: Provide information about your current health condition and any specific issues or concerns you would like the chiropractor to address.
03
Step 3: Mention any relevant medical history, previous injuries, or ongoing treatments that the chiropractor should be aware of.
04
Step 4: If you have any insurance coverage, provide the necessary details for billing and reimbursement purposes.
05
Step 5: Read and understand the terms and conditions of the clinic's policies, such as cancellation or rescheduling procedures.
06
Step 6: Sign and date the welcome form to indicate your consent and agreement with the provided information.

Who needs welcome to zivkovic chiropractic?

01
Anyone seeking chiropractic care or treatment for musculoskeletal conditions can benefit from visiting Zivkovic Chiropractic.
02
Individuals experiencing back pain, neck pain, joint discomfort, headaches, or other related issues may find relief through chiropractic adjustments and therapies.
03
People with sports injuries, work-related injuries, or those looking to improve overall wellness and optimize their body's functionality can also benefit from the services offered by Zivkovic Chiropractic.
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Welcome to Zivkovic Chiropractic is an introduction and informational guide for new patients providing details about the practice, services offered, and what to expect during visits.
New patients seeking chiropractic services at Zivkovic Chiropractic are required to fill out the welcome form.
To fill out the welcome form, patients should provide their personal details, medical history, and any specific health concerns they wish to address.
The purpose of the welcome form is to gather relevant patient information to ensure tailored and effective chiropractic care.
Patients must report their personal information, medical history, current symptoms, and any medications they are taking.
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