Patient Forms

Personal History form to complete

Click Here to view and print Personal History Form PDF

Please print this form, fill it out and bring it to us on your initial visit.

 

Informed Consent to Receive Networks Spinal Analysis (NSA) Care

Click Here to view, print, and sign Informed Consent to Receive Network Spinal Analysis (NSA) Care PDF

Please read this form, print and sign it, then bring it to us on your initial visit.

 

Special Notice for Medicare and Insurance Patients

Click Here to view, print, and sign the Special Notice for Medicare and Insurance Patients.

Please read this form, print and sign it, then bring it to us on your initial visit.

 

Privacy Practices

Click Here to view our Notice of Privacy Practices PDF

Click Here to print and sign that you have read the Notice of Privacy Practices Signature Page PDF

Please read our Notice of Privacy Practices and then print and sign the Signature Page and bring the Signature Page to us on your initial visit.

 

Heal, Vitalize, Love and Live Fully!

Consultation, Spinal Exam and Two Network Adjustments ($150 value)

Heal, Vitalize, Love & Live Fully