Record Release WCC Address

DR. ELIZABETH HOEFER, DC, DCCJP

26302 LA PAZ ROAD SUITE 214

MISSION VIEJO, CA 92691

949-359-8385

Record Release Request

I hereby authorize

Name: Well Connected Chiropractic

Address: 26302 La Paz Rd. Suite 214

City: Mission Viejo         State: CA          Zip Code: 92691

To release information regarding the following (Please check all boxes that apply)

To:

If yes, please complete the following in its entirety.

If no, please disregard the following.

I understand that there is a $15 shipping fee for my imaging that will be paid over the phone with a credit card before the imaging will be mailed. If the shipping fee exceeds $15, I will be responsible to pay the difference.

Get in Touch

Address:
26302 La Paz Road, Suite 214

Mission Viejo, CA 92691

Phone Number:

Call Office : 949-359-8385

Text Office: 949-619-6545

Hours of Operation

Monday | 9:00am – 5:30pm

Tuesday | 9:00am – 5:30pm

Wednesday | 7:30am – 11:30am

Thursday | 9:00am – 5:30pm

Friday | Closed

Sat & Sun | Closed

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