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    Confidential Patient Health Record for Chiropractic Treatment


    Chiropractors, have each new patient fill out this Confidential Health Record and Information Sheet prior to receiving chiropractic treatment.

    The 5-page form includes sections for:
    • personal and medical history,
    • job-related injuries,
    • current health condition, and
    • a patient consent form for chiropractic treatment.
    This Confidential Health Record and Information Sheet for Chiropractic Treatment is fully editable and reusable. Pay for the form once, and it's yours to use as often as you require.
    Download Type: Microsoft Word
    Last Updated: 14-April-2016
    SKU: 2990