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Practice Name

Ellenberger Chiropractic

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Primary Location
740 W Main St
Mount Joy, PA 17552
Phone: 717-653-9176
Fax: 717-653-9276

Office Hours

DayMorningAfternoon
MondayOpen 9:00Close 8:00
Tuesday9:00 - 12:001:00 - 6:00
WednesdayOpen 9:00Close 8:00
ThursdayClosedClosed
FridayOpen 9:00Close 6:00
SaturdayClosedClosed
SundayClosedClosed
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In order to provide you the best possible wellness care, please complete this form

Patient Data

Mailing Address

Current Complaints

Nature of Injury

Insurance Information

*If an auto accident, please provide:

Signatures

Name of the Insured _____________________________________________

I understand and agree that health/accident insurance policies are an arrangement between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment, any fees for professional services rendered to me will be immediately due and payable.

Patient's signature _______________________________________________

Date ____________________

Spouse's or guardian's signature __________________________________

Date ____________________

Medical History

Have you ever:

Family History

Habits

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New patients receive 15% OFF first visit.

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Testimonial

I really like Dr. Ellenberger. He is caring and takes his time with us. I don’t feel rushed like with many other doctors. I really like my monthly adjustment.

F -
Mount Joy, PA


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Our Services

We strive to provide complete care for our patients. Learn more about all the services we provide.
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Contact

Ellenberger Chiropractic
740 W Main St
Mount Joy, PA 17552
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  • Phone: 717-653-9176
  • Fax: 717-653-9276
  • Email Us

Office Hours

DayMorningAfternoon
MondayOpen 9:00Close 8:00
Tuesday9:00 - 12:001:00 - 6:00
WednesdayOpen 9:00Close 8:00
ThursdayClosedClosed
FridayOpen 9:00Close 6:00
SaturdayClosedClosed
SundayClosedClosed
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