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PATIENT INFORMATION BRUCE RIZZO DC

PATIENT INFORMATION BRUCE RIZZO DC 2025

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4.4 out of 5

58 votes

The document is a comprehensive patient information form for Bruce Rizzo DC, a chiropractic office located in Oakland, CA. It includes sections for personal details, patient evaluation regarding current health complaints, health history, and financial policies related to payment and appointment management. The form aims to gather essential information to assist in the patient's chiropractic care and outlines the office's policies on billing and missed appointments.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the date at the top of the form. This helps establish a timeline for your records.
Fill in your name, including your preferred name, last name, first name, and middle name if applicable.
Provide your complete address, including state, city, and zip code. This information is crucial for contact purposes.
Enter your email and phone numbers. Indicate which number is best for contact by checking the appropriate box.
Complete the personal details section including birth date, gender, marital status, occupation, and pronouns.
In case of emergency, provide a contact's information along with their relationship to you.
Proceed to fill out the patient evaluation section by describing your present complaints and answering all relevant questions regarding pain characteristics and history.
Finally, review all entries for accuracy before signing and dating the form at the bottom.

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Versions	Form popularity	Fillable & printable
2023	4.4 Satisfied (58 Votes)
2011	4.1 Satisfied (22 Votes)

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