Pickaway Chiropractic Center in Circleville OH
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            • Dr. Christina Dick D.C.
              • Dr. Joshua Dick D.C. C.C.E.P.
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              • What is Chiropractic?
                • How can Chiropractic Help?
                  • Subluxation
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                              • Schedule an Appointment

                               Here are the basic forms for new patients.  Please download and fill out the Adult History Form, Financial Policy Form, and the Informed Consent.  If your child has an appointment with us download the Child History Form instead of the Adult History Form.  If you have any questions regarding the forms please give us a call  or we can address them at your appointment. 

                              Adult History Form
                              File Size: 38 kb
                              File Type: pdf
                              Download File

                              Please print and fill out this form completely.

                              For all patients 
                              Financial Policy
                              File Size: 11 kb
                              File Type: pdf
                              Download File

                              This form covers our office financial policies.  Please read and sign, if you have any questions, feel free to call or ask at the time of your appointment.

                              For all patients
                              Informed Consent
                              File Size: 4 kb
                              File Type: pdf
                              Download File

                              Please read over this form and bring with you.  We will discuss treatment options and any questions you have. 

                              For all patients
                              Child History
                              File Size: 10 kb
                              File Type: pdf
                              Download File

                              This form is for our pediatric (under 8) patients.  Please fill out completely for your child and bring with you.
                              Pickaway Chiropractic Center in Circleville Ohio 778 North Court Circleville OH Phone:(740) 474 - 5352 Email: pickawaychiro@yahoo.com Dr. Joshua Dick D.C. C.C.E.P. Dr. Christina Dick D.C.