DIRECT ACCESS PATIENT ATTESTATION AND MEDICAL RELEASE …
CURRENT CARE AND ATTESTATION. Please . check one below: Company staff members contacted and administrative section. I . AM . NOT. under the care of a licensed health practitioner for the symptoms listed on this form and I wish to seek physical therapy care at this time. (Licensed health practitioner includes a doctor of medicine, osteopathy, chiropractic, podiatry, dental surgery, licensed ... ................
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