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Practice Name

Rochester Chiropractic Center

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Primary Location
18234 Sargent Rd. SW
Rochester, WA 98579
Phone: 360-273-9174
Fax: 360-273-9683

Office Hours

DayMorningAfternoon
Monday8:30 - 113 - 6
TuesdayClosed3 - 6
Wednesday8:30 - 113 - 6
ThursdayClosedClosed
Friday8:30 - 113 - 6
Saturday10 - 11Closed
SundayClosedClosed
Main Content

In order to provide you the best possible wellness care, please complete this form

Patient Data

Mailing Address

Current Complaints

Nature of Injury

Insurance Information

*If an auto accident, please provide:

Signatures

Name of the Insured _____________________________________________

I understand and agree that health/accident insurance policies are an arrangement between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment, any fees for professional services rendered to me will be immediately due and payable.

Patient's signature _______________________________________________

Date ____________________

Spouse's or guardian's signature __________________________________

Date ____________________

Medical History

Have you ever:

Family History

Habits

Have you ever suffered from:

Exclusive Offer

New Patients Receive a Comprehensive $39 Initial Exam

You will receive a chiropractic exam, x-rays (if needed), diagnostic testing, & treatment consultation. These services are valued at $350.

Sign-up using the form or call us at 360-273-9174 to take advantage of this exclusive offer.






Testimonial

It was my lucky day when you stopped me at the fair.  Your treatments have taken away my arthritis pain, given me more energy and helped me to handle the stresses in my life.

Jan -
Rochester, WA

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Services

We strive to provide complete care for our patients. Learn more about all the services we provide.

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Contact

Rochester Chiropractic Center
18234 Sargent Rd. SW
Rochester, WA 98579
Get Directions
 
  • Phone: 360-273-9174
  • Fax: 360-273-9683
  • Email Us
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Office Hours

DayMorningAfternoon
Monday8:30 - 113 - 6
TuesdayClosed3 - 6
Wednesday8:30 - 113 - 6
ThursdayClosedClosed
Friday8:30 - 113 - 6
Saturday10 - 11Closed
SundayClosedClosed

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