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Personal and Family Health History Date_____ Name chiropractic care, we will work to remove these interferences to your natural health expression so that you can live the quality of life you deserve. ... Access Document
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Personal and Family Health History Social Security Occupation Employer Marital Status: Spouse's Name Spouse's Occupation previous Chiropractic Care: Yes Reason Reason Reason D Name Address Phone: (H): E-mail Date of Birth Oceanside, NY 11572 (516) 766-1717 NOTICE OF PRIVACY PRACTICES PA ... Doc Viewer
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