So you want to be an ACTIVE THERAPY patient with Better Call Doc?

Great! We want to help you.

Let's start with your medical history,

then you will consult directly with Dr. Rice.

IT TAKES APPROXIMATELY 6 MINUTES TO COMPLETE THIS SECTION

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Confidential Medical History
ACTIVE THERAPY INTAKE FORM
Please complete in addition to this form:
MY INSURANCE & PAYMENT INFO *1
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General
Cardio-vascular
Skin
Gastro-intestinal
Genito-urinary
For women only
Respiratory
Have you eve been diagnosed with:
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I understand that Dr. Michel Rice is formally my doctor of chiropractic who I am consulting with on the subject matter described in this form.

I understand that Dr. Michel Rice clinically directs the active therapy program. Dr. Rice works with the my fitness practitioner for both program supervision and clinical re-evaluations.