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New Patient Health History Form
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In order to provide you the best possible wellness care, please complete this form
Name of the Insured _____________________________________________
I understand and agree that health/accident insurance policies are an arrangement between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment, any fees for professional services rendered to me will be immediately due and payable.
Patient's signature _______________________________________________
Spouse's or guardian's signature __________________________________
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We strive to provide complete chiropractic care for our patients in the Atlanta, Decatur, and North Druid Hills areas of Georgia. Learn more about all the services we provide.
"I love coming to Sherwood Chiropractic Center not only for the competent care that I receive, but also for the friendly people and community."
Erin H. -
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