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Practice Name

CoreZone Chiropractic

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Primary Location
200 West 57th Street, Suite 909
New York, NY 10019
Phone: 212-873-0907
Fax: 646-669-7308

Office Hours

DayOpenClose
MondayBy Appt.By Appt.
Tuesday8am - 1pm3pm - 7pm
WednesdayBy Appt.By Appt.
Thursday8am - 1pm3pm - 7pm
FridayBy Appt.By Appt.
SaturdayClosed
SundayClosed
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In order to provide you the best possible wellness care, please complete this form

Patient Data

Mailing Address

Current Complaints

Nature of Injury

Insurance Information

*If an auto accident, please provide:

Signatures

Name of the Insured _____________________________________________

I understand and agree that health/accident insurance policies are an arrangement between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment, any fees for professional services rendered to me will be immediately due and payable.

Patient's signature _______________________________________________

Date ____________________

Spouse's or guardian's signature __________________________________

Date ____________________

Medical History

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Family History

Habits

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Featured Services

Services We strive to provide complete care for our patients. Learn more about all the services we provide. Book An Appointment



Online Forms Our patient forms are available online so they can be completed in the convenience of your own home or office.

Office Hours

DayOpenClose
MondayBy Appt.By Appt.
Tuesday8am - 1pm3pm - 7pm
WednesdayBy Appt.By Appt.
Thursday8am - 1pm3pm - 7pm
FridayBy Appt.By Appt.
SaturdayClosed
SundayClosed
Day Open Close
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
By Appt. 8am - 1pm By Appt. 8am - 1pm By Appt. Closed Closed
By Appt. 3pm - 7pm By Appt. 3pm - 7pm By Appt.

Contact

  • 200 West 57th Street, Suite 909 New York, NY 10019
  • 212-873-0907
  • Get Directions
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