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Practice Name

Wilcox Chiropractic Clinic

Primary Location
527 S.E. Baseline, Suite D
Hillsboro, OR 97123
Phone: (503) 640-3943
Fax: (503) 640-9546

Office Hours

DayMorningAfternoon
Monday8 -5
Tuesday8 -5
Wednesday8 -5
Thursday8 -5
FridayClosedClosed
SaturdayBy Appt.Closed
SundayClosedClosed
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Patient Data

Mailing Address

Current Complaints

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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

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Family History

Habits

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New patients receive 15% OFF first visit.

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Services

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Contact

Wilcox Chiropractic Clinic
527 S.E. Baseline, Suite D
Hillsboro, OR 97123
Get Directions
 
  • Phone: (503) 640-3943
  • Fax: (503) 640-9546
  • Email Us

Office Hours

DayMorningAfternoon
Monday8 -5
Tuesday8 -5
Wednesday8 -5
Thursday8 -5
FridayClosedClosed
SaturdayBy Appt.Closed
SundayClosedClosed
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