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Home › New Patient Intake Forms

New Patient Intake Forms

Please click on the link below to download the New Patient Intake Form:

new patient paper work 2020

Office Info

(248) 593-8282

Chiropractic Wellness Center
Dr. Marc Terebelo, DC
30555 Southfield Rd, Suite 155
Southfield, MI 48076

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Mon - Wed, Friday
9:00 am – 1:00 pm,
3:00 - 7:00 pm

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This site is for informational and educational purposes only. The information contained on this site does not constitute the rendering of healthcare advice or treatment recommendations. Browsing this site does not establish a professional relationship with our clinic. The information contained on this website has not been evaluated by the F.D.A. and is not intended to treat, diagnose or cure any disease.

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