Complimentary Scoliosis Screening

Scoliosis Screening, Including Thoracic X-ray

Applies to children under 18 years of age

North Georgia Spinal Care, the office of Rob Buchkowski, D.C.    

650 Henderson Drive, Suite 109 Cartersville, GA 30120

(770) 387-2265

As part of our complimentary scoliosis screening, the consultation, examination, and any need thoracic x-rays will be provided to children under 18 years of age at no cost.  There is no separate charge for the evaluation of diagnostic tests or procedures.  Any further treatment or services will be provided at the rates regularly charged by this office. 

I understand and agree to the terms stated above:

__________________________________________

Signature                                      

__________________________________________

Date

__________________________________________

Witness