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Practice Name

Kernan Chiropractic Center

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Primary Location
11900 Atlantic Blvd. Suite 226
Jacksonville, FL 32225
Phone: 904-338-9400
Fax: 904-338-9404

Office Hours

Day
Monday8:30 -12:002:00 - 5:00
Tuesday3:00 - 6:00
Wednesday8:30 -12:002:00 - 5:00
Thursday
Friday8:30 - 12:003:00 - 6:00
Saturdayby appointment only
Sunday
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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:

Our New HydroMassage

 

Ask about our free 10 minute demo on our HydroMassage bed.

We participate in the following PPO plans:

Jacksonville Participation

Dr. Wetzork is the official Chiropractor for the Jacksonville Sharks Arena Football Team .

Our Office Hours

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Our Services

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

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Contact

Kernan Chiropractic Center
11900 Atlantic Blvd. Suite 226
Jacksonville, FL 32225
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  • Phone: 904-338-9400
  • Fax: 904-338-9404
  • Email Us
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Office Hours

Day
Monday8:30 -12:002:00 - 5:00
Tuesday3:00 - 6:00
Wednesday8:30 -12:002:00 - 5:00
Thursday
Friday8:30 - 12:003:00 - 6:00
Saturdayby appointment only
Sunday
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