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Buckner Chiropractic & Rehabilitation Services Patient Information Date:___ How did you hear about us? ___ First Name: ___ MI: ___Last Name: ___ Address: ___City: ___ State: ___ Zip: ___ Day Time
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Start by making an appointment with Buckner Chiropractic & Rehabilitation.
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Fill out the intake form provided by the clinic with your personal information and medical history.
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Be thorough and honest when completing the form to ensure the chiropractor has all the necessary information.
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Arrive at the clinic on time for your appointment and hand in the completed form to the receptionist.

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Individuals experiencing chronic pain or discomfort in their body.
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Buckner Chiropractic & Rehabilitation is a healthcare facility that specializes in chiropractic care and rehabilitation services, aiming to relieve pain, improve mobility, and enhance overall physical functioning.
Individuals who have received chiropractic services from Buckner Chiropractic & Rehabilitation may be required to file forms for insurance reimbursement or medical record documentation.
Filling out the Buckner Chiropractic & Rehabilitation forms requires accurate personal information, details of the services received, and a signature for consent, which must be followed as per their specific guidelines.
The purpose of Buckner Chiropractic & Rehabilitation is to provide patients with comprehensive chiropractic care and rehabilitation to address physical ailments, enhance recovery from injuries, and promote wellness.
Information required includes patient demographics, treatment details, diagnosis codes, insurance information, and any associated medical history relevant to the services provided.
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