Chiropractic
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Chiropractic New Patient
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This is your first visit for this service, or your first time in over 3 years.
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Please continue in the next section NAME & GENDER
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Chiropractic Continued Care Visit
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You are new to the practice and are following a doctor directed care plan.
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My symptoms have...
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Primary Area of Symptoms
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Secondary Area(s) of Symptoms
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Chiropractic Regular Maintenance
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You are for regular maintenance or maybe it's just a while and you're due.
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(Optional) Areas of Focus
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Chiropractic New Issue
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You've been here before but an entirely new issue has occured and needs to be evaluated for the first time.
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Was this due to an AUTO of WORK injury?
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What is the new issue?
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Acupuncture
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Wellness Visit (Acu)
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(Optional) Areas of Focus
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Continued Care (Acu)
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My symptoms have...
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Primary Area of Symptoms
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Secondary Area(s) of Symptoms
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Additional Health Concerns to Address
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New Complaint (Acu)
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What this due to an AUTO or WORK injury?
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What is the new complaint?
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Massage
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Any areas of focus needed?
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Cold Laser Therapy
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