Patients
Make Appointment
Intake and Forms
New Patients
Feedback
Services
Softwave TRT Q & A
Chiropractic Care
Back Pain
Car Accidents
DOT Physicals
Headache
Neck Pain
Nerve Pain
Weight Loss
Workers’ Comp Injuries
About
Patient Success Stories
Staff
Careers
Contact
✓ Make Appointment
Hablamos Español
(610) 789-1800
Directions
Facebook
Feedback
How would you rate your care?
*
five
four
three
two
one
Waiver
*
I accept
I acknowledge that I am not including any protected health information (PHI) in my inquiry. I understand that any such information should be presented in person or securely over the phone with my health care provider. PHI, as defined by HIPAA (Health Insurance Portability and Accountability Act) includes, but is not limited to, any information that relates to 1) the past, present, or future physical or mental health or condition of an individual, 2) the provision of health care to an individual or 3) the past, present, or future payment for the provision of health care to an individual that identifies the individual or with respect to which there is a reasonable basis to believe the information can be used to identify the individual.
I consent to allow any and all electronic communications with this recipient. These communications include this form and all others on this website, emails, text messages and website comments. I understand that electronic communication is not secure and that any information that I provide here may be visible to third parties or unintended recipients. I waive my rights under HIPAA to the extent that they can be waived and, in the event that any PHI is provided within this message or related messages, do not hold the recipient liable to any breaches or disclosures of the information provided in this message.
Will you help us by leaving a public rating?
*
It only takes a few seconds! If so, you will be redirected automatically once you click “Submit”.
Yes
No
Name (Optional)
First
Last
Name
First
Last
Email
Phone
How can we improve?
*
Email
This field is for validation purposes and should be left unchanged.