When having x-rays or MRI's done please bring report and CD in for the doctor to review.
Form and Letter Fee
This is to notify you that the Mt. Penn Chiropractic Center DBA The Spine and Wellness Center will apply a fee of $20.00 to your account for patient, companies, family members, insurance carriers or other person requesting form and/or letters to be completed.
Forms include, but not limited to FMLA, disability, motor vehicle division, continuation of pay, payment of car loans, payment of mortgages, industrial information, etc. Letters include, but are not limited to, attorneys, insurance companies, employers, schools, airlines, travel agents, gyms, etc.
In order to comply with federal laws including HIPAA, as well as Pennsylvania state and federal statues, this office must have a signed authorization from the patient / responsible party stating who we are authorized to release information to. You can find this form on our website or you can contact our office and we can mail or fax the form to you. Please be sure to sign the form. Unsigned requests cannot be processed.
- Family Medical Leave Forms(FMLA)
- Disability Forms
- Physical Forms