Phone 410-629-0610

The following forms can be filled out at home and help you get a head start on paper work.

Directions for downloading and saving are as follows:

• If you do not have AdobeReader® installed on you computer, click here to download.
• Download the form to your personal computer by right hand clicking on the form link(s) provided and selecting save target as, note the location where you are saving the form and select open after saving.  This will bring the form up in adobe acrobat, which you will then be able to print out.
• Print it out and fill in the fields by hand.
• You can Fax the filled out form to 410-629-0712 or you can scan the form in and send it in as an attachment. Email completed forms or send any questions to the following email address:
• info@drsrush.com
• If filling out the form by hand, make sure you fill out all fields, legibly. Mail or bring in the filled in form to the following address:
• Healing Hands Chiropractic P.C.
  10776 Grays Corner Rd. #8
  Berlin, MD 21811

Name Revision Date New Patient Registration Form 2009-04-13 Start here if you are new to Healing Hands Chiropractic