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All new patients are required to complete and submit the following forms:
Some additional forms may be required. Please complete and submit any of the forms below that may apply:
Please download and complete the applicable forms from the list below. Upon completion, you may either submit them via the form above, or via email attachment to: Email: belmont.chiro.clinic@gmail.com. Please include any additional relevant medical notes or documents.
Valid 12/09/23 through 01/02/24
Use for spinal decompression, shockwave, and stretch therapy packages
Utilize your leftover HSA/flex account funds towards purchase of therapy packages
Use coupon code "HOLIDAY15" at checkout to claim your deal!!