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Chiropractic Health Center of Parma Michael F. Urbanc D.C.
To Schedule An Appointment
Call:
216-898-1445
Text:
216-868-7301
Email: contact@chcparma.com
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New Patients send forms to:
contact@chcparma.com
Insurance / Cash Intake Forms
Patient Intake Form
Medical History Form
Consent to Care
HIPPA Privacy Notice
Auto Injury Intake Forms
Patient Intake Form
Medical History Form
PI Accident Description
Consent to Care
PI Insurance Info
HIPPA Privacy Notice
Release of Records
Doctors Lien
Worker's Comp Injury Intake Forms
Patient Intake Form
Medical History Form
Description of Accident
C-23
C-86.pdf
HIPPA Privacy Notice
FROI-1 (New Claim)
Release of Records
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