Dear Client,

Please take a moment to complete the attached form and return to this email or fax to *|USER:PHONE|*. 

Feel free to ask about the many services available to you and your family at Central Chiropractic. 

Thank you,

*|MY_NAME|*
*|USER:COMPANY|*
*|USER:URL|*
*|USER:PHONE|*
(800)555-5555
Intake Form.pdf