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New Patient Forms

Hello.  I'm Carrie Norton, Office Manager/Chiro­practic Assistant, at Plantation Medical Rehab & Wellness.  I  look forward to meeting you at your upcoming appointment.  Plantation Medical Rehab & Wellness offers our patient form(s) online so you can complete it in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or, if you prefer,  bring it with you to your appointment.
        Our fax number is 954-577-4447.

Auto Accident and Personal Injury ­ ­
(Please be sure to download and print form parts 1 and 2)

Download & Print Form part 1

Download & Print Form part 2­


Health Insurance
(Please be sure to download and print form parts 1 and 2)

Download & Print Form part 1

Download & Print Form part 2


Self Pay Patients

Download & Print Form


Workers Comp

Download & Print Form


Email Privacy Policy Form

Download & Print Form


Download the Free AdobeReader®