Bertram Healing Center
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Bertram Healing Center

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filler@godaddy.com

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Bertram's chiropractic office offering DOT Physicals

 Federal Motor Carrier Safety Administration 

 

Medical Applications and Forms

  • Medical Examination Report Form (MCSA-5875) 
  • Insulin-Treated Diabetes Mellitus Assessment Form MCSA-5870 
  • Vision Evaluation Report, Form MCSA–5871
  • Medications Form, MCSA-5895 Form 9-11-2023 

DOT Exam Preparation List (pdf)

Download

Nutrition Response Testing Documents

Client Intake Form - NRT (pdf)

Download

Systems-Survey-Form (pdf)

Download

Permission and Authorization Form - NRT (pdf)

Download

Daily Record of Food Intake (pdf)

Download

Chiropractic Care Documents

Client Intake Form - Chiropractic (pdf)

Download

Disclosure & Consent - Chiropractic (pdf)

Download

Patient Health Questionnaire (pdf)

Download

Body Work Documents

Client Intake Form - Body Work (pdf)

Download

Consent and Release Form - Cupping Therapy (pdf)

Download

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