Better Life Chiropractic
226 King St.
Midland, ON L4R 3M2
(705) 526-6600
betterlife@rogers.com
Info
Care
Consent
First Name:
Last Name:
Birthday:
Male
Female
Names of Parents/Guardians:
Address:
City:
Postal Code:
Home Phone #:
Email:
Family Doctor's Name:
Phone #:
Next
Cancel Form Entry