Evans Chiropractic Health Center

Forms

Please fill out forms in Black Ink

Confidential Patient Information
Confidential+Patient+Information+
Confidential Patient Info revised 01-201[...]
Adobe Acrobat document [476.2 KB]

Privacy Notice
Privacy+Notice+w+Semi-Open+adj
Privacy Notice w Semi-Open adj.pdf
Adobe Acrobat document [222.7 KB]

Release of Information Form
Release of Information Form.pdf
Adobe Acrobat document [15.8 KB]

Consent for Treatment and Authorization to Perform X-rays
Consent for X-rays.pdf
Adobe Acrobat document [118.0 KB]

Terms of Acceptance
Terms of Acceptance.pdf
Adobe Acrobat document [120.5 KB]

Missed Policy
Missed Appointment Policy.pdf
Adobe Acrobat document [17.2 KB]

Written Financial Policy
Written Finanacial Policy.pdf
Adobe Acrobat document [19.5 KB]

Treatment of a minor
Treatment of a minor.pdf
Adobe Acrobat document [282.8 KB]

Release of X-rays to Dr. Rice Office
Release of Records-xrays.pdf
Adobe Acrobat document [102.7 KB]

Release of Records from Dr. Rice
Release of Records from Dr. Rice.pdf
Adobe Acrobat document [7.0 KB]

Contact Us Today!

Evans Chiropractic Health Center
108 Srp Drive STE A
Evans, GA 30809

Phone: 1.706.860.4001

Fax: 1.706.860.6520

E-mail:

admin@drbillrice.com

Facebook: https://www.facebook.com/evanschc

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