Switch to Main Site
Practice Name

Millbrook Family Chiropractic

Social Media
Primary Location
3363 Alabama 14
Millbrook, AL 36054
Phone: (334)285-8483
Fax: (844)654-7165

Office Hours

DayMorningAfternoon
Monday7 - 12pm2 - 6pm
Tuesday7 - 12pmClosed
Wednesday7 - 12pm2 - 6pm
Thursday7 - 12pmClosed
Friday7 - 12pm2 - 6pm
SaturdayClosedClosed
SundayClosedClosed
Main Content

In order to provide you the best possible wellness care, please complete this form

Patient Data

Mailing Address

Current Complaints

Nature of Injury

Insurance Information

*If an auto accident, please provide:

Signatures

Name of the Insured _____________________________________________

I understand and agree that health/accident insurance policies are an arrangement between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment, any fees for professional services rendered to me will be immediately due and payable.

Patient's signature _______________________________________________

Date ____________________

Spouse's or guardian's signature __________________________________

Date ____________________

Medical History

Have you ever:

Family History

Habits

Have you ever suffered from:

Sign-up using the form or call us at (334)285-8483 to make your appointment.

Name: *
Email: *
Phone: *

Services

We strive to provide complete care for our patients. Learn more about all the services we provide.

View Services

Follow Us

3D Spine Simulator


 
Launch
 3D Spine Simulator

Office Hours

DayMorningAfternoon
Monday7 - 12pm2 - 6pm
Tuesday7 - 12pmClosed
Wednesday7 - 12pm2 - 6pm
Thursday7 - 12pmClosed
Friday7 - 12pm2 - 6pm
SaturdayClosedClosed
SundayClosedClosed

Request an Appointment

(334)285-8483

Contact

Millbrook Family Chiropractic
3363 Alabama 14
Millbrook, AL 36054
Get Directions
  • Phone: (334)285-8483
  • Fax: (844)654-7165
  • Email Us
From:  To:  Get Directions
Driving Directions: Reverse Directions Print Directions
Newsletter

Newsletter Sign Up










Community Content