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| 715 Lake Point Centre Drive, Suite 127, O'Fallon, Illinois 62269 |
| 618-628-1111 |
| OPTIONAL FORMS |
| The information contained in this form let’s us know what’s happened to you, but perhaps more important, where you want to take your health now? |
| NEW PATIENT INTAKE FORMS - Required For All New Patients |
You’re busy and we know it! We respect your time and that is why you can now access
your patient intake forms online before your visit. This will allow you to complete your
forms in the convenience of your own home. Simply print and complete the appropriate
paperwork below and bring them with you during your first visit to our office.
your patient intake forms online before your visit. This will allow you to complete your
forms in the convenience of your own home. Simply print and complete the appropriate
paperwork below and bring them with you during your first visit to our office.
| Each form is a PDF document file. If you do not already have Adobe Reader® installed on your computer, click the Adobe® image to download a copy for free. |
| CLICK ADOBE ICON TO DOWNLOAD AND PRINT NEW PATIENT INTAKE FORMS |
| AUTO ACCIDENT FORM |
| The information contained on these forms will help let us know what’s happened to you and cut down on your visit time once you arrive at our office. |
| WORK INJURY FORM |
| FREE ADOBE READER® DOWNLOAD |
| (CLICK ON ADOBE® IMAGE TO DOWNLOAD AND PRINT FORM) |
| EVERYTHING !!! |
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| COPYRIGHT, 2005-2010 WALTON CS-XII, P.C. DBA MAY CHIROPRACTIC. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE DUPLICATED, PUBLISHED, BROADCAST, REWRITTEN, USED, OR DISTRIBUTED, WITHOUT EXPRESSED WRITTEN CONSENT FROM WALTON CS-XII, P.C. DBA MAY CHIROPRACTIC AND THE STIMULUS GROUP LLC. |
| DISCLAIMER: THIS WEBSITE IS NOT INTENDED TO DIAGNOSE ANY CONDITION, NOR DOES IT REPLACE A VISIT TO YOUR HEALTH CARE PROFESSIONAL. |
