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Madison Clinic
(256) 430-2700

Millar Chiropractic - Madison
New Patient Forms





Millar Chiropractic Madison

1908 Slaughter Rd
Madison Alabama 35758
(256) 430-2700

Re: New Patient Forms

Instructions: Please take about 20 min and fill out your New Patient Input Form before you arrive. This will save both of us time. After you have filled out the form online please sign and submit it to us.  You will find a submit button at the bottom of the form. You may print out a copy for your records if you like. 

Click the link below and you will be taken to a secure new patient portal. 

https://www.mychirotouch.com/patientintake/?clientid=MCNC0001 

Thanks
Dr. Justin Walbom, DC and
the Staff of Millar Chiropractic Madison