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Chiropractic / Manipulative therapy / Pain / Spinal adjustment / Veterinary chiropractic / Chiropractor / Neck pain / Low back pain / Back / Medicine / Alternative medicine / Health


Chiropractic New Patient Personal Information Name __________________________________ Birth Date ____/____/____ Today’s Date ____/____/____ Phone (H) _______________________ (W) _______________________ Ext. _____ (Cell
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Document Date: 2012-03-14 20:52:12

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Company

Life Sense / /

IndustryTerm

healthcare / /

MedicalCondition

disc injuries / pain / Hand pain / Work Injury / serious injury / injury / headaches / Vertebral artery injuries / Motor Vehicle Injury / cysts Heart problems Neck Pain Anemia / such injuries / stroke / Throat Problems Numbness / injuries / /

MedicalTreatment

Chiropractic / manual therapy / /

Organization

Or Mission / /

Person

Happiness Ease / /

Position

Motion Comfort Sitting/Standing General / healthcare advisor / chiropractor / chiropractor / including spinal adjustment / /

SocialTag