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Jeanette Chomic, D.C.
/ HOME
// ABOUT US
/// FORMS
//// OFFICE STAFF
///// NEW PATIENTS
////// CONTACT
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All patients will need to sign the following four forms :
Notice of Privacy Practices
HIPAA Consent Form
Consent Forms
Financial Agreement
New patient forms
(please complete only the form for your age group)
:
New Patient Intake 10 years and older
New Patient Intake 3-10 years old
New Patient Intake 0-2 years old
Re-exam form
(more than 6 months but less than 3 years since last visit
)
:
Intake Paperwork for Re-Exam
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