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5957 MCKEE ROAD, FITCHBURG, WI 53719 • (608)273-2222 • FAX (608)273-2227 • info@dynamicchiro.net
DYNAMIC CHIROPRACTIC CLINIC
Of Fitchburg, LLC
© 2008 Dynamic Chiropractic LLC All rights reserved.
608-273-2222
PATIENT FORMS
For faster service, please review and, if appropriate, complete the following forms and bring them with you to your first visit to Dynamic Chiropractic.
Consent for Use or Disclosure of Health Information Form
Payment Policy Form
(for cash and insurance payments)
Payment Policy Form
(for Worker’s Compensation and Personal Injury payments)