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Donna Lieberman, DC & Howard Lieberman, DC
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All patients please complete 
Back Index &/or Neck Index     
Privacy Form
 
HealtheConnections authorization


And, one of the forms below that applies to your insurance situation. 

All Medicare Part B or C  History and Policy Form

​Worker's Compensation: C3 &  BTHC Addendum to C3    Agreement 

Automobile Accident: MVA History Form  

No Insurance or out of network Major Medical:  Non-Insured Form 

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