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Patient Forms | Dr. Keith Zimmermann Manchester NH Chiropractor

Forms

Card on file Authorization Form

Consent to treat a minor, if less than 18 yrs. of age

HIPAA Signature Page

HIPAA_Notice_of_Privacy_Practices

Neck Disabilitiy (Given if neck pain)

New Patient Questionaire

Oswestry (Given if lower back pain)

Pain Diagram

Payment insurance sheet revised 5-16-2019