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Back Country Chiropractic · settled or within three months of the date of my last treatment,...

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Page 1: Back Country Chiropractic · settled or within three months of the date of my last treatment, whichever occurs first. If I settle my case with a Third Party, the check for my treatment

Page 2: Back Country Chiropractic · settled or within three months of the date of my last treatment, whichever occurs first. If I settle my case with a Third Party, the check for my treatment

Page 3: Back Country Chiropractic · settled or within three months of the date of my last treatment, whichever occurs first. If I settle my case with a Third Party, the check for my treatment

Page 4: Back Country Chiropractic · settled or within three months of the date of my last treatment, whichever occurs first. If I settle my case with a Third Party, the check for my treatment

Page 5: Back Country Chiropractic · settled or within three months of the date of my last treatment, whichever occurs first. If I settle my case with a Third Party, the check for my treatment

Page 6: Back Country Chiropractic · settled or within three months of the date of my last treatment, whichever occurs first. If I settle my case with a Third Party, the check for my treatment

Page 7: Back Country Chiropractic · settled or within three months of the date of my last treatment, whichever occurs first. If I settle my case with a Third Party, the check for my treatment

Page 8: Back Country Chiropractic · settled or within three months of the date of my last treatment, whichever occurs first. If I settle my case with a Third Party, the check for my treatment

Page 9: Back Country Chiropractic · settled or within three months of the date of my last treatment, whichever occurs first. If I settle my case with a Third Party, the check for my treatment

Page 10: Back Country Chiropractic · settled or within three months of the date of my last treatment, whichever occurs first. If I settle my case with a Third Party, the check for my treatment

Page 11: Back Country Chiropractic · settled or within three months of the date of my last treatment, whichever occurs first. If I settle my case with a Third Party, the check for my treatment

Page 12: Back Country Chiropractic · settled or within three months of the date of my last treatment, whichever occurs first. If I settle my case with a Third Party, the check for my treatment

Page 13: Back Country Chiropractic · settled or within three months of the date of my last treatment, whichever occurs first. If I settle my case with a Third Party, the check for my treatment

Page 14: Back Country Chiropractic · settled or within three months of the date of my last treatment, whichever occurs first. If I settle my case with a Third Party, the check for my treatment

Page 15: Back Country Chiropractic · settled or within three months of the date of my last treatment, whichever occurs first. If I settle my case with a Third Party, the check for my treatment

Page 16: Back Country Chiropractic · settled or within three months of the date of my last treatment, whichever occurs first. If I settle my case with a Third Party, the check for my treatment

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