Fairbanks Chiropractic Clinic

Fairbanks Chiropractic ClinicFairbanks Chiropractic ClinicFairbanks Chiropractic Clinic

Fairbanks Chiropractic Clinic

Fairbanks Chiropractic ClinicFairbanks Chiropractic ClinicFairbanks Chiropractic Clinic
  • Home
  • Dr. Gappert
  • New Patients
  • Good Faith Estimate
  • Massage Therapists
  • Office Staff
  • Contact
  • More
    • Home
    • Dr. Gappert
    • New Patients
    • Good Faith Estimate
    • Massage Therapists
    • Office Staff
    • Contact
  • Home
  • Dr. Gappert
  • New Patients
  • Good Faith Estimate
  • Massage Therapists
  • Office Staff
  • Contact

New Patient Forms

Please print and complete new patient forms prior to initial appointment. If you are a patient with Medicare, please also bring a completed ABN to your appointment. 

Child (0-2) New Patient Packet (pdf)

Download

Adolescent (3-12) New Patient Packet (docx)

Download

Adult (13+) New Patient Packet (pdf)

Download

Release of Medical Information (pdf)

Download

Functionality Assessment (pdf)

Download

Medicare ABN 2020 (pdf)

Download

Copyright © 2022 Fairbanks Chiropractic Clinic - All Rights Reserved.

  • Good Faith Estimate

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