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quirozchiropractic.com · QUIROZ CHIROPRACTIC Dr. Pierre and Emilee Quiroz INFORMED CONSENT TO CHIROPRACTIC TREATMENT I hereby request and consent to the performance of chiropractic

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Page 1: quirozchiropractic.com · QUIROZ CHIROPRACTIC Dr. Pierre and Emilee Quiroz INFORMED CONSENT TO CHIROPRACTIC TREATMENT I hereby request and consent to the performance of chiropractic
Page 2: quirozchiropractic.com · QUIROZ CHIROPRACTIC Dr. Pierre and Emilee Quiroz INFORMED CONSENT TO CHIROPRACTIC TREATMENT I hereby request and consent to the performance of chiropractic
Page 3: quirozchiropractic.com · QUIROZ CHIROPRACTIC Dr. Pierre and Emilee Quiroz INFORMED CONSENT TO CHIROPRACTIC TREATMENT I hereby request and consent to the performance of chiropractic
Page 4: quirozchiropractic.com · QUIROZ CHIROPRACTIC Dr. Pierre and Emilee Quiroz INFORMED CONSENT TO CHIROPRACTIC TREATMENT I hereby request and consent to the performance of chiropractic
Page 5: quirozchiropractic.com · QUIROZ CHIROPRACTIC Dr. Pierre and Emilee Quiroz INFORMED CONSENT TO CHIROPRACTIC TREATMENT I hereby request and consent to the performance of chiropractic
Page 6: quirozchiropractic.com · QUIROZ CHIROPRACTIC Dr. Pierre and Emilee Quiroz INFORMED CONSENT TO CHIROPRACTIC TREATMENT I hereby request and consent to the performance of chiropractic
Page 7: quirozchiropractic.com · QUIROZ CHIROPRACTIC Dr. Pierre and Emilee Quiroz INFORMED CONSENT TO CHIROPRACTIC TREATMENT I hereby request and consent to the performance of chiropractic
Page 8: quirozchiropractic.com · QUIROZ CHIROPRACTIC Dr. Pierre and Emilee Quiroz INFORMED CONSENT TO CHIROPRACTIC TREATMENT I hereby request and consent to the performance of chiropractic
Page 9: quirozchiropractic.com · QUIROZ CHIROPRACTIC Dr. Pierre and Emilee Quiroz INFORMED CONSENT TO CHIROPRACTIC TREATMENT I hereby request and consent to the performance of chiropractic

Chiropractic Pain-Wellness Care, P.C....Chiropractic Pain-Wellness Care, P.C. 2220 Vestal Pkwy East, 1St Floor Phone: 607-235-2662 Vestal, NY 13850 Informed Consent to Chiropractic

Chiropractic Pain-Wellness Care, P.C....Chiropractic Pain-Wellness Care, P.C. 2220 Vestal Pkwy East, 1St Floor Phone: 607-235-2662 Vestal, NY 13850 Informed Consent to Chiropractic

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