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Lisa Wakefield, FNP-BC
Corinne Bender, DC
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Pain Library
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Services
Medication Management
Chiropractic Care
Providers
Lisa Wakefield, FNP-BC
Corinne Bender, DC
New Patients
Pain Library
CALL NOW (602) 603-2282
New Patients
start Here
Submit this form as your intent to become a patient and we will be in contact within 1 business day.
First Name
Phone Number
Email
Anything you want us to know?
Service Needed
Pain Management
Chiropractic
Massage
Do you have a referral?
Yes
No
Have you ever been in pain management before?
Yes
No
Form of Payment
Cash Pay
AHCCCS
Private Insurance (UHC, BCBS, UMR, Cigna, Aetna)
THIS FORM IS FOR NEW PATIENTS ONLY. PLEASE DO NOT SOLICIT SERVICES THROUGH THIS FORM.
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