- We strive to provide complete care for our patients. Learn more about all the services we provide.
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This lets us know the history and current state of your health.
1. Fill in each form from the link above.
2. MUST save the form onto your computer (Desktop), prior to emailing.
Medicare Patients - (Must select and fill out at least ONE of the forms below ex. Neck pain or Back pain.)
Neck Pain - If you have neck pain, please select "Neck Pain" form and answer 1 though 10 questions. Only select one answer person question.
Back Pain - If you have back pain, please select "Back Pain" form and answer 1 though 10 questions. Only select one answer person question.
Or to fax:
If you are able to fax the requested document, please click here and fax back to 302-892-3494.
Please review the Informed Consent to Chiropractic Treatment form.
Please review the Notice of Privacy Practices Effective: September 23, 2013
|Monday||9 AM - 12 PM||2 PM - 7 PM|
|Tuesday||8 AM - 12 PM||2 PM - 6 PM|
|Wednesday||8 AM - 12 PM||2 PM - 6 PM|
|Thursday||No Morning Appts. (Special Arrangements only)||2 PM - 7 PM|
|9 AM - 12 PM||8 AM - 12 PM||8 AM - 12 PM||No Morning Appts. (Special Arrangements only)|
|2 PM - 7 PM||2 PM - 6 PM||2 PM - 6 PM||2 PM - 7 PM|
I have benefited tremendously from the chiropractic care I received from Dr. Hollstein.