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Home > Application For Care
Please fill out this form as completely and accurately as possible.
The information I have provided, on this case history form, is true and accurate, to the best of my knowledge. I give Dr. Craig Nugent and Dr. Christina Petersen permission to render care to me today. This initial visit includes a health history/consultation, chiropractic exam/evaluation, and any initial care that is determined to be clinically necessary and mutually agreed upon.