Patient Information Sheet

DOWNLOAD.PRINT.SCAN.SUBMIT

Please DOWNLOAD the Patient Form and then PRINT it to fill-up the necessary fields

Your Info Are Fully Protected

Just tap on the button then you can easily DOWNLOAD or directly PRINT out the form by farther actions. Fill-up all necessary fields. When you’re finished, just SCAN the papers and UPLOAD them to “Submit the Form”↓option↓.

Check out our other Services:

Pain Relieving Services

Solution to Back Pain, Neck Pain & Headache. Safe, effective and provides long term relief.

Sports/Athletic Pain

Dr. Williams is board certified as a Certified Chiropractic Sports Physician or CCSP.

Auto Injury Recovery

Combination of chiropractic care, rehabilitative exercise, and care of the soft tissues.

Now click on CHOOSE FILES and Upload/Attach the Scanned papers. Submit it with your Name, Email and Phone no. THANKS!

Dr. Alex Williams

DC, MS, CCSP

Email

info@acutechiro.net

Call

(253) – 426 – 1000

Submit the Form