Primary Care & Chiropractic Primary Care & Chiropractic
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Patient Paperwork

Please feel free to print and fill out the paperwork to bring to your appointment.  As a new patient, you will need to fill out the first four forms.  If the patient is under the age of 18, the parent must sign all forms, including the minor consent form. 
 
After downloading and printing each form, please close that file and click on the back button to access another form.

Patient Information

Financial Agreement

HIPPA Form

Consent Form

Minor Consent Form

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Primary Care & Chiropractic Center
9265 S Broadway Ste 200 | Highlands Ranch, CO 80129 | Ph: (303) 683-3377 | Fax: (303) 683-1453 | kesnerchiro@qwest.net