Windmill Chiropractic Wellness

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. If there is additional information you would like the doctor to be aware of prior to your initial appointment, please email Dr. Gargiula directly at: drg4ldt@gmail.com. Thank you - we look forward to seeing you in the office!

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