Body Back Chiropractic; Dr. Vance

Patient Intake Form

Welcome to the Body Back Chiropractic and Physiotherapy Patient Intake Form. 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 assure this is completed in full prior to your visit, including all pertinent insurance information. Please take a moment to read through the authorization message before signing.

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