Making Chiropractic Affordable
Customer On-Boarding - Welcome to NuSpine!
  • 1 Account Setup your account
  • 2 More Information Additional Medical Information
  • 3 Pain Index Describe your pain points
  • 4 Plan Payment Choose a Payment Option
  • 5 Finish
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Referral Source *



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Yes No
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Motor Vehicle Injury Sport Injury Work Injury Slip and Fall Injury
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Yes No Not Sure



Yes No
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Type of Hospitalization/Surgery Date of Event
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Please Describe Your Pain Levels

Dots Indicate Your Potential Pain Areas

Click the dots to fill your out your pain levels

- Indicates Pain Area
- Indicates Selected Area
- Indicates Identified Pain Area
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Products

Please select a product below
Product One-Time Recurring Number of Adjustments
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Skip Payment - Pay In The Clinic
OR

Payment

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    Total: {{totalPrice |currency}}
    Total Monthly: {{selectedProduct.recurringPrice | currency}} / Month

    I will pay at the front desk


    WE'RE ALMOST DONE!
    I am over the age of 19 or I am the parent or legal guardian of the patient whose information is completed in the previous intake forms.

    By clicking finish you agree to our Terms and Privacy Statements
    View NuSpine Informed Consent
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