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Home > Documents > KM C368-20180308160302 - Chiropractor in Middlesboro, KY · AUTHORIZATION AND RELEASE: I authorize...

KM C368-20180308160302 - Chiropractor in Middlesboro, KY · AUTHORIZATION AND RELEASE: I authorize...

Date post:	20-Jul-2020
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Page 1: KM C368-20180308160302 - Chiropractor in Middlesboro, KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office.

Page 2: KM C368-20180308160302 - Chiropractor in Middlesboro, KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office.

Page 3: KM C368-20180308160302 - Chiropractor in Middlesboro, KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office.

Page 4: KM C368-20180308160302 - Chiropractor in Middlesboro, KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office.

Page 5: KM C368-20180308160302 - Chiropractor in Middlesboro, KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office.

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