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scan0020 - Loertscher Chiropractic Clinic · Reason for today's visit: Emergency New injury Old injury Chronic pain Wellness Are you in pain: u Yes O No Rate your pain with the following

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Page 1: scan0020 - Loertscher Chiropractic Clinic · Reason for today's visit: Emergency New injury Old injury Chronic pain Wellness Are you in pain: u Yes O No Rate your pain with the following
Page 2: scan0020 - Loertscher Chiropractic Clinic · Reason for today's visit: Emergency New injury Old injury Chronic pain Wellness Are you in pain: u Yes O No Rate your pain with the following