Get X-ray Refusal Form - Schofield Chiropractic Training

Filling out the X-Ray Refusal Form at Schofield Chiropractic Training is an important step in your care process. This guide provides clear instructions to help you navigate each section of the form with ease.

Follow the steps to complete the form online:

1. Press the ‘Get Form’ button to access the X-Ray Refusal Form and open it in the online editor.
2. In the first section, enter the name of the office where you are receiving care.
3. Next, fill in the name of the doctor who is recommending the x-rays.
4. Provide the street address of the office clearly in the designated field.
5. Fill in your city, state, and ZIP code in the corresponding fields.
6. Input the phone number of the office to ensure proper communication.
7. In the acknowledgement section, after the comma, state your name followed by ', D.C.' to indicate who the recommendation is from.
8. Clearly express your reasons for refusing the x-rays by stating 'I do not feel that my present condition is serious enough to warrant the use of x-rays.'
9. Indicate the name of the doctor in the blank space provided after 'Dr.' who will be responsible for your care.
10. Read the statement regarding the responsibility you assume and ensure you understand it before proceeding.
11. Write the date of execution in the specified space.
12. Sign the form in the designated area to complete your acknowledgment.
13. After filling out all the necessary fields, choose to save the changes, download, print, or share the completed form as needed.

Complete your X-Ray Refusal Form online today!