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MindBody MED Patient Intake How did you hear about us? ___ Who is your primary physician? ___Clinic or Hospital? ___ PATIENT INFORMATIONFORMATION Patient Name: ___ Date of Birth: ___ Sex: ___ Pronouns:
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Provide your personal information including name, address, and contact details.
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Individuals seeking chiropractic care for various health concerns.
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Patients looking for an alternative approach to managing pain or improving overall wellness.
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Abundant Health Chiropractic refers to a wellness approach that emphasizes holistic health and well-being through spinal adjustments and chiropractic care.
Individuals seeking chiropractic services or businesses offering chiropractic care may be required to file for certain health insurance reimbursements or regulatory purposes.
Filling out the Abundant Health Chiropractic form typically involves providing personal information, details about chiropractic services received, and any relevant insurance information.
The purpose of the Abundant Health Chiropractic process is to facilitate access to chiropractic care, ensure proper record-keeping, and comply with health insurance or regulatory requirements.
Information such as patient demographics, treatment details, dates of service, and payment information must be reported on the form.
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