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Fletcher Heights Chiropractic
20783 N. 83rd Ave, Ste #110
Peoria, AZ 85382
Phone: 623-209-2000
Fax:     623-209-2001
Dr. Nicholas Jay, D.C.
Dr. George Kukurin, D.C.

Please download the forms below, and print them out. Fill them in as completely as you possibly can before coming to the office for your first visit. You will need Adobe Acrobat Reader to read, and print out these files. You can get the latest version of Adobe Acrobat Reader by clicking on the image below:

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Patient Registration Form

HIPAA Consent Form

 

 

Phone: 623-209-2000
Fax:     623-209-2001
20783 N. 83rd Ave. Suite 110
Peoria, Arizona 85382

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