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Practice Name

Petersen Chiropractic

Primary Location
151 NE State Route 300
Belfair, WA 98528
Phone: (360) 275-8727
Fax: (360) 275-9695

Office Hours

DayMorningAfternoon
Monday8:30-11:30 AM2:00-6:00 PM
Tuesday2:00 PM6:00 PM
Wednesday8:30-11:30 AM2:00-6:00 PM
Thursday2:00 PM6:00 PM
Friday8:30-11:30 AM2:00-6:00 PM
Saturday9:00 AM10:00 AM
SundayClosedClosed
Main Content

In order to provide you the best possible wellness care, please complete this form

Patient Data

Mailing Address

Current Complaints

Insurance Information

*If an auto accident, please provide:

Signatures

Name of the Insured _____________________________________________

I understand and agree that health/accident insurance policies are an arrangement between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment, any fees for professional services rendered to me will be immediately due and payable.

Patient's signature _______________________________________________

Date ____________________

Spouse's or guardian's signature __________________________________

Date ____________________

Medical History

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Family History

Habits

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Featured Services

Services We strive to provide complete care for our patients. Learn more about all the services we provide. Make An Appointment We will do our best to accommodate your busy schedule. Schedule an appointment today! Online Forms Our patient forms are available online so they can be completed in the convenience of your own home or office.

Testimonials

Chiropractic care is essential to overall good health. I have been a patient at Petersen Chiropractic for over 10 years now and I highly recommend Dr Petersen.

Lisa Hornyak, NMHS English Instructor
Belfair, WA

Office Hours

DayMorningAfternoon
Monday8:30-11:30 AM2:00-6:00 PM
Tuesday2:00 PM6:00 PM
Wednesday8:30-11:30 AM2:00-6:00 PM
Thursday2:00 PM6:00 PM
Friday8:30-11:30 AM2:00-6:00 PM
Saturday9:00 AM10:00 AM
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8:30-11:30 AM 2:00 PM 8:30-11:30 AM 2:00 PM 8:30-11:30 AM 9:00 AM Closed
2:00-6:00 PM 6:00 PM 2:00-6:00 PM 6:00 PM 2:00-6:00 PM 10:00 AM Closed

Contact

  • 151 NE State Route 300 Belfair, WA 98528
  • (360) 275-8727
  • Get Directions
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