Chiropractic Health Center of Parma Michael F. Urbanc D.C.

To Schedule An Appointment

Call 216-898-1445

Insurance / Cash Intake Forms

Patient Intake Form

Medical History Form

Consent to Care

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Auto Injury Intake Forms

Patient Intake Form

Medical History Form

Accident Description

Consent to Care

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Worker's Comp Injury Intake Forms

Patient Intake Form

HIPPA Privacy Notice

Accident Description

FROI-1 (New Claim)

Medical History Form