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Please Bring to Your Adjustment Appointment

Bring With You:

Current Insurance Information & Card
Cash, Credit Card, or co-pay funds
Name, Phone #, & Fax # of any referring physicians for correspondence
Date of the last prior adjustment, if any
Know which type of band you have implanted (if this is not clear contact your surgeon or facility where surgery was performed for this information and keep it in a personal file)

Your name: *

E-mail: *

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Homepage:

Comment: *

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