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We've gathered our intake forms for new patients here. Please choose the form corresponding with what insurance type your filing with, or "Self Pay" for out of pocket paying patients. Not sure which forms you'll need? Please call us for further direction. 
 

New Patient Forms //

Disclaimer:
Statements made in this website are based on studies and traditional uses of the ingredients of the products, customers' testimonials, and reported results from the use of such products. *These statements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. Please consult your medical practitioner before using any health products. Notwithstanding the provisions of sections 17 U.S.C. § 106 and 17 U.S.C. § 106A, the fair use of a copyrighted work, including such use by reproduction in copies, phonorecords, or by any other means specified by that section, for purposes such as criticism, comment, news reporting, teaching (including multiple copies for classroom use), scholarship, or research, is not an infringement of copyright.


E'town Chiropractic complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

E'town Chiropractic & Naturopathic complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Website design by Ivy Curl, Dr. Tindall, and Wix.

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