Full Name
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Appointment Type
PM
Neuro
PI
FM
MAF
Appointment Date/Time
Providercheck
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All Case Types Created
Referral Source: How did you hear about us?
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On a scale of 0 - 10 how important is it for you to get this problem corrected?
Patients Why/What it is impaction in their life:
Our Doctors combined have over 100 years of experience in treating conditions such as these. Let’s hope we can help you too. (If Neuro, have you seen the Neuropathy video?)
Because we have had an overwhelming response to this offer, we do ask for a deposit to secure your appointment:
Deposit Type
HA $149
TA $89
FM $50
Neuro $49
Do you have any previous imaging? When can we get ahold of it?
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