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Patient Data

Mailing Address

Please Describe Your Current Symptoms:

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Insurance Information

*If an auto accident or personal injury, please provide attorney information (if applicable):

I understand and agree that health/accident insurance policies are an arrangement between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment, any fees for professional services rendered to me will be immediately due and payable.

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Medical History

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Family History

Habits

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New Patients Welcome: Call 947-1199


 

Top 10 Chiropractors in Bangor 2015
 

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Office Hours

Day
Monday7 - 122 - 5
TuesdayclosedClosed
Wednesday7 - 122 - 5
ThursdayClosedClosed
Friday7 - 122 - 5
SaturdayClosedClosed
SundayClosedClosed
Day
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
7 - 12 closed 7 - 12 Closed 7 - 12 Closed Closed
2 - 5 Closed 2 - 5 Closed 2 - 5 Closed Closed

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