Monthly Chiropractic Wellness Subscriptions!

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Affordable Chiropractic Wellness Subscriptions!

Adult Wellness Plan
$49.99/month
Includes 2 adjustments per month!

**first time patients pay $35 initiation fee for initial exam prior to first adjustment

Children’s Wellness Plan
$29.99/month
Includes 2 adjustments per month!

**first time patients pay $20 initiation fee for initial exam prior to first adjustment

Fill out the form below to subscribe!

please note: form is intended for one patient at a time. Please fill out multiple forms for multiple patients.

Step 1 of 2

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Patient Name*
First Last
Email*
Phone*
Are you a first time patient?*
- Yes
- No
Please choose which best describes you.
Choose a Wellness Plan*
- Adult
- Child
Please choose which best describes you.

First Time Patient Fee*
Price: $20.00
First Time Patient Fee*
Price: $30.00
Subscription Monthly Amount*
Price: $49.99
Subscription Monthly Amount*
Price: $29.99
Billing Address*
Street Address Address Line 2 City State ZIP Code
Credit Card*

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Card Number Expiration Date Security Code Cardholder Name
Total
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