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Patient Data

Mailing Address

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Insurance Information

*If an auto accident, please provide:

Signatures

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.

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Date ____________________

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Medical History

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Contact

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Accelerated Chiropractic
717 Atlantic Ave
Morris, MN 56267
Get Directions
  • Phone: (320) 585-7246
  • Fax: (320) 585-7247
  • Email Us

Office Hours

Day
Monday8am-1pm2pm-5:30pm
Tuesday8am-1pm2pm-5:30pm
Wednesday8am-1pm2pm-5:30pm
Thursday8am-1pm2pm-5:30pm
Friday8am-1pm2pm-4pm
SaturdayBy Appt.Closed
SundayClosedClosed

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