Greenway Cotton Chiropractic

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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 call our office should you have any further questions 623-433-8895. If you are unable to complete this form, please arrive 15 minutes prior.

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Let's get started. Fill out the fields below to speed up your office visit.