cash pay paperwork

New Patient Paperwork:
Cash Pay Only

For our patients who prefer to pay without insurance, please download the form below and complete it prior to your visit. This will help streamline the intake process so we can get you into treatment faster and one extra step closer to relief!
Call if you have any questions

If you have questions, please feel free to call us or the contact form below.

Call (386) 320-0325

Office Hours:
Monday
8am-1pm, 2pm-5pm
Tuesday
12pm-7pm
Wednesday
8am-1pm, 2pm-5pm
Thursday
2pm-6pm
Friday
8am-2pm
Saturday
9am-1pm BI-WEEKLY
Sunday
Closed
Office: 386-320-0325
Fax: 386-320-0318
10 Dogwood Trail, Suite B
Debary, FL 32713
2024 Health In Motion Chiropractic