New Patient Special Offer

Macomb Twp Chiropractic

        New Patient Special

    ----FREE CONSULTATION----
Fill Out The Fields Below

Name: 

Address: 

City:

Phone #:

Email:

Please list your current health complaints, questions and concerns and where you heard about us(Face Book, Twitter, YouTube, Christian Pages, Health Fair, Massage Event, Radio Show, Friend, Chamber, Doctor, Phonebook, News Paper etc...).
  Are you suffering with:

     Neck Pain  - Upper Back Pain  - Low Back Pain  - Disc Problems
     Headaches  - Sciatic  - Shoulder Pain  - Arm Pain  -  Leg Pain
     Numbness  - Carpal Tunne   - Hip Pain  - Sinus Problems
  
Disclaimer: Medicare and Medicaid Patients Not Included
  MUST COMPLETE FORM TO RECIEVE NEW PATIENT SPECIAL
Common Conditions