As a thank you for your service to our country, Corrective Chiropractic will be offering complimentary chiropractic services to 1 active service member or veteran per clinic.

Please fill out the questionnaire to apply and thank you for your service.

patriots

Name *

Email *

Date of birth *

Preferred Location

Choose which Corrective Chiropractic branch you prefer to be treated

Are you an Active Service Member or Veteran? *

Which branch did you serve? *

When did you serve? *

Why would you like to receive chiropractic care? *

Have you been under chiropractic care in the past? *