NEW PATIENT SPECIAL OFFER! Please print out this form and bring it in to the office during your appointment. If you are a new client, please also fill out the relevant forms on the Online Form page and bring it in with you to your appointment.
ChiroMed Health Alliance Inc.
1-866-63-CHIRO (24476)
Note: This program is not available for any Federally Funded program such as Medicare, Campus, Tricare etc.
The patient and any other person responsible for payment has a right to refuse to pay, cancel payment, or be reimbursed for payment for any other service, examination, or treatment which is performed as a result of and within 72 hours of responding to the advertisement for the free, discounted fee, or reduced service, examination or treatment. |
