Runyon Upper Cervical Chiropractic

Patient Intake Form

Welcome to our online 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 be as thorough as possible and answer all questions, your insurance company may ask for records and it is crucial that your intake reflect medical necessity. You are taking the first step in getting your life back and we look forward to being a part of your journey! Dr. Runyon and Staff

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