Rodgers Chiropractic & Laser

Patient Intake Form

Welcome to our online Patient Intake Form for Rodgers Chiropractic & Laser therapy. The information you fill in will be sent directly to our office, speeding up your office visit and allowing us to better serve your healthcare needs. Please make sure you read through the Consent to Treat paragraphs at the bottom, because it also contains our Policies and fees statement as well as the Privacy Guidelines. By signing, you agree that you have read and understand all the statements in the section. Thank you and we look forward to seeing you real soon!

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