Patient Management

DESCRIPTION	ITEM #	PRICE
Accident History Questionnaire	004	36.00
Appointment Book	040	28.00
Appointment Hours	968	14.00
Assignment Direct Payment	053	8.00
Consultation History	113	10.00
Consultation History (3-page)	313	29.00
Counter Checks	117	12.75
Dismissal Card	126	12.75
Dismissal Letter	124	8.00
Exam Form	226	22.00
Family Health History	127	8.00
Follow-up Patient Progress Report	131	8.00
General Release of X-rays	137	6.00
Hardship Agreement	141	8.00
Health Care Service Agreement	384	36.00
Hiring Package (Chiropractic)	2003	99.00
Initial Patient Progress Report	161	8.00
Insurance Verification Form	007	8.00
Chiropractic Insurance Policy	165	8.00
Interim Report	167	12.95
Look at Your Posture	185	8.00
Missed Appointment Log	190	8.00
New Patient for Today	615	8.00
New Patient Routing Form	195	8.00
Office Policy Ins. Assignment	980	8.00
Oswestry Questionnaire	132	12.95
Our Patients Speak Testimonial	912	8.00
Patient Care Insurance Agreement-Counter Check	983	8.00
Patient Care Insurance Agreement-Credit Card	979	8.00
Patient Condition Assessment	162	12.95
Patient Insurance Record	991	8.00
Patient Policies	243	23.00
Patient Progress Graph	669	18.00
Patient Symptom Evaluation	870	8.00
Personal Appointment Calendar	261	26.00
Phone Consultation Form	1100	8.00
Recall Postcards	100	42.00
Reminder Cards	206	12.75
Sign-In Sheet	303	15.00
Six Month Stress Check Up	319	23.00
To The New Patient	355	36.00
Travel Card	344	23.00
Travel Card (11x17)	345	36.00
Update Report	363	8.00
X-ray Release Form	373	8.00

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