No. of antibiotics prescribed:
During the following times, a child’s spine is most vulnerable and should routinely be checked by aDoctor of Chiropractic for Prevention and Early Detection of the Subluxation Complex.At what Age was your child able to:
I hereby authorize this clinic and its Doctor(s) to administer care as they so deem necessary toMy Son / Daughter / Ward.
Signature on file and authorization to release medical information:I HEREBY AUTHORIZE PAYMENT OF INSURANCE BENEFITS DIRECTLY TO THE DOCTOR FORSERVICES PROVIDED. I FURTHER AUTHORIZE THE DOCTOR TO RELEASE ANY INFORMATIONREQUIRED TO PROCESS INSURANCE CLAIMS.