Office:

972-644-4744
Fax:
972-644-4449
Email:
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Our whole staff welcomes you to the ASAP SPINAL HEALTH website.  We have applied great effort to accommodate and educate you about Chiropractic within this website.  So please browse around and use some of our useful tools.  If you need additional information or want to tell us something then just contact us and we'll be glad to help you out.

RCC Staff

 

Option 1

   
 1. Please choose a day and time below that is convenient for you.
Mon - Thurs -

or

Friday -  
   

 2. Please fill out the below Insurance Verification Form

Name

Date of Birth
Ex: MM/DD/YY

Social Security Number
City
State
ZIP Code
Home Phone
Area Code
Phone
Work Phone
Area Code
Phone
Employer Name
 
Health Insurance - Primary          Secondary        Auto/PI        WC
Name of Insured
Relation
 
Social Security Number
Policy Number
Group Number
Insurance Company Name
Phone Number
Area Code
Phone
 
Address
City
State
ZIP
 Fill Out the Form below if you have Coverage other than what you chose above.
Health Insurance - Primary          Secondary        Auto/PI        WC
Name of Insured
Relation
 
Social Security Number
Policy Number
Group Number
Insurance Company Name
Phone Number
Area Code
Phone
 
Address
City
State
ZIP

Email:  

If you don't have an Email then please type the word   none

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