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Page 1: Maxwell Chiropractic Clinic...Drugs you now take: None D Nerve Pills Pain killers Muscle relaxers a "Pep" pills a Blood Insulin Birth control Stomach pills Date oflast physical examination
Page 2: Maxwell Chiropractic Clinic...Drugs you now take: None D Nerve Pills Pain killers Muscle relaxers a "Pep" pills a Blood Insulin Birth control Stomach pills Date oflast physical examination
Page 3: Maxwell Chiropractic Clinic...Drugs you now take: None D Nerve Pills Pain killers Muscle relaxers a "Pep" pills a Blood Insulin Birth control Stomach pills Date oflast physical examination
Page 4: Maxwell Chiropractic Clinic...Drugs you now take: None D Nerve Pills Pain killers Muscle relaxers a "Pep" pills a Blood Insulin Birth control Stomach pills Date oflast physical examination
Page 5: Maxwell Chiropractic Clinic...Drugs you now take: None D Nerve Pills Pain killers Muscle relaxers a "Pep" pills a Blood Insulin Birth control Stomach pills Date oflast physical examination

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