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Request Appointment

Dilliard Chiropractic P.C. offers our patient's a short form for essentials that we will need to set up your file.  The remainder of your paperwork will be completed when you arrive at the office for your first visit.

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  • Download the form, print it out and fill in the required information.
  • Fax us your printed and completed form as soon as possible to FAX# (619) 447-2493
  • or you may Scan and Email them to our email address:  TeamDilliard@gmail.com

New Patient Form

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