To make your first visit easier and save time at the clinic, we ask all new patients to complete our Application for Treatment form in advance. Please download the form below, fill it out at home, and send it back to us before your appointment — or simply bring it with you on your first visit.
Click the button below to download both Application for Treatment form and Privacy Practices Acknowledgment form as a PDF.
You Must Print them both and complete all required fields, including your medical history and contact details.
Email both of the completed form to sutantochiropractic@yahoo.com Or mail it to:
907 US HWY 491, Gallup, NM 87301 Or bring it with you on the day of your appointment.
Need help with the form? Call us at (505) 979-1937 and we’ll be glad to assist you.
