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Forms

ACCOUNT INFORMATION - NEW PATIENT FORM SERIES

$19.95

It is good risk procedure to keep financial records seperate from diagnostic and patient information. The Account Information form organizes type of case, insurance coverage, and insured's information. The back of the form contains releases necessary to do insurance business on the patient's behalf and a seperate section to thoroughly document insurance verification as it applies to your services.

PAD OF 100 - 8.5" X 11" - 2 SIDED

ISBN/SKU: 
227002

APPOINTMENT REMINDER - PACK OF 50, 4" X 6" Use this card to remind patients of their commitment.

$9.95

                                                                                                                                                                                                                                                                                                                           Use this card to remind patients of their commitment.

Pack of 50 - 4" X 6"

ISBN/SKU: 
224035

AUTHORIZATION FOR ABSENCE - MINI PAD

$7.95

These patient management forms are practice fundamentals. Priced for convenience, they can be kept throughout the clinic so you never have to make a patient wait.

PAD OF 100 - 4.25" X 5.5"

ISBN/SKU: 
224144

AUTHORIZATION FOR RELEASE OF HEALTHCARE RECORDS - MINI PAD

$7.95

These patient management forms are practice fundamentals. Priced for convenience, they can be kept throughout the clinic so you never have to make a patient wait.

PAD OF 100 - 4.25" X 5.5"

ISBN/SKU: 
224342

AUTONOMIC NERVOUS SYSTEM FORM

$19.95

Demonstrate the Spine's Connection to Body Function. This piece has been used by thousands of clinics to explain the spine and nervous system's relationship to the organs, tissues and glands of the body. This time-tested tool is consistently among our top sellers. Few single handouts have been employed as much as this one to get patients connected to the chiropractic message.  When incorporated into your report of findings, each patient can understand the intricate connection between the spine and body function.

PAD OF 100 - 8.5" X 11"

ORDER THE MATCHING 24" X 36" READY TO FRAME POSTER

ISBN/SKU: 
224002

AUTONOMIC NERVOUS SYSTEM FORM - NEW

$19.95

Demonstrate the Spine's Connection to Body Function. This form is an updated version of the original Autonomic Nervous System.

PAD OF 100 - 8.5" X 11"

ORDER THE MATCHING 24" X 36" READY TO FRAME POSTER

ISBN/SKU: 
224099

BACK CARE PROGRAM

$19.95

This Piece Is Perfect for Spinal Care Classes.

So many people go through life without caring for their spine.  How can you expect your patients to change if they don't understand basic spinal care?  Start new patient treatment plans correctly by teaching this basic information that will help them adapt behaviors to support their chiropractic care.

PAD OF 100 - 8.5" X 11" - 2 SIDED

ISBN/SKU: 
223997

CASE HISTORY

$19.95

This Case History form is a Parker Classic.  As a very affordable choice, this form has been used by thousands of clinics.

PAD OF 100 - 8.5" X 11" - 2 SIDED

ISBN/SKU: 
224050

CHIROPRACTIC CARE CERTIFICATE - MINI PAD

$9.95

These patient management forms are practice fundamentals. Priced for convenience, they can be kept throughout the clinic so you never have to make a patient wait.

PAD OF 100 - 4.25" X 5.5"

ISBN/SKU: 
224005

CONFIDENTIAL PATIENT CASE HISTORY

$19.95

                                                                                                                                                                                                                                                                                                                                                 PAD OF 100 - 8.5" X 11"

ISBN/SKU: 
224327

CONSENT TO TREATMENT OF MINOR CHILD

$7.95

These patient management forms are practice fundamentals. Priced for convenience, they can be kept throughout the clinic so you never have to make a patient wait.

PAD OF 100 - 4.25" X 5.5"

ISBN/SKU: 
224007

DISABILITY CERTIFICATE

$7.95

These patient management forms are practice fundamentals. Priced for convenience, they can be kept throughout the clinic so you never have to make a patient wait.

PAD OF 100 - 4.25" X 5.5"

ISBN/SKU: 
224333

DUPLICATE APPOINTMENT CARD

$9.95

These very affordable reminders can pay for themselves thousands of times over by making sure your patients stay on schedule.

PACK OF 50 - 2.25" X 4"
Carbonless Duplicate Cards

ISBN/SKU: 
224009

MULTIPLE APPOINTMENT PROGRAM

$9.95

Take the monotony out of patient management.  Make your procedures flow and increase the convenience-factor for your patients by mapping out all the visits for the entire treatment plan.  Now your patients will know exactly how chirpractic fits in their schedule and when payments are due and progress exams and reports are scheduled.

PACK OF 100 - 2.125" X 3.375"

ISBN/SKU: 
224012

MYPAL 10 BINDER - ONLY

$19.95

                                                                                                                                                                                                                                                                                                                                        Maroon Binder

ISBN/SKU: 
224058

MYPAL 10 MONTHLY DIVIDERS

$19.95

                                                                                                                                                                                                                                                                                                                                                                            12 Months

ISBN/SKU: 
224057

MYPAL 10 SCHEDULE REFILL PAGES

$19.95

** 6 Month Supply  ** 10 Minute Appointment Pages  ** 12 Columns Per Day  ** Double-sided With 8 Hours Of Time

ISBN/SKU: 
224054

MYPAL I BINDER - ONLY

$19.95

                                                                                                                                                                                                                                                                                                                                                                          Forest Green

ISBN/SKU: 
224063

MYPAL I MONTHLY DIVIDERS

$19.95

                                                                                                                                                                                                                                                                                                                                                                                 12 Months

ISBN/SKU: 
224062

MYPAL I SCHEDULE REFILL PAGES

$25.95

** 6 Month Supply  ** 15 Minute Appointment Pages  ** 6 Columns Per Day With Color Coded, Staggered tabs  ** Double-sided

ISBN/SKU: 
224053

MYPAL II BINDER - ONLY

$19.95

                                                                                                                                                                                                                                                                                                                                                                                   Navy Blue

ISBN/SKU: 
224073

MYPAL II MONTHLY DIVIDERS

$19.95

                                                                                                                                                                                                                                                                                                                                                                               12 Months

ISBN/SKU: 
224072

MYPAL II SCHEDULE REFILL PAGES

$24.95

** 6 Month Supply  ** 15 Minute appointment pages  ** 12 Columns per day with color-coded, staggered tabs (seperated into weeks)      ** Double-Sided with 10 hours of time on each side

ISBN/SKU: 
224071

NERVE FUNCTION FORM

$19.95

Broaden Your Patient's Focus

This handout graphically illustrates how the spine and nervous system relate to complete neurological, musculoskeletal, and visceral function.

PAD OF 50 - 8.5" X 11"- ENGLISH

ISBN/SKU: 
224619

NERVE FUNCTION FORM - SPANISH

$19.95

Broaden Your Patient's Focus

This handout graphically illustrates how the spine and nervous system relate to complete neurological, musculoskeletal, and visceral function.

PAD OF 50 - 8.5" X 11" - SPANISH

ISBN/SKU: 
221229