Family Chiropractic and Nutrition Family Chiropractic and Nutrition
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  • Meet The Practitioner
  • Functional Medicine
  • Nutrition
  • Chiropractic Care
  • Services
    • 28 Day Purification Programs
    • Chiropractic Care
    • Lending Library
    • Mini- Health Food Store
    • Nutritional Analysis
    • Nutritional supplements
  • Purification
  • New Patient Forms
  • Contact Us

New Patient Forms

Please print and complete the following forms and bring to your initial appointment.

Nutrition Schedule

Cause Form

Wellness Actions

New Patient Information Page 1

New Patient Information Page 2

Permission and Authorization

 

HIPAA Notice 1-2017

The following HIPAA information is available for your perusal.  We will provide you with a paper copy upon request.

HIPAA Booklet – 10-16-13.pdf

Order Standard Process Here

Contact Us

Family Chiropractic & Nutrition
Barbara Mitchem, DC, ACN
1123 Fannin St.
P. O. Box 627
Columbus, TX 78934
email: familychironutrition@yahoo.com
979-733-9500

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