New Patient Form

Offices of Dr. Howard Furshman and Dr. Maureen Davis

Questions? Please contact us:

South Miami: (305) 668-9545

Hallandale: (954) 241-0145

Ocean Reef: (305) 668-9545

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I authorize release of any information necessary to process my insurance claims only. I also assign and request direct payment to my physician if I utilize Medicare or personal injury protection insurance.
I hereby notify all concerned that I neither suspect nor know positively at this time that I may be pregnant. I release this clinic from any and all damages arising from any and all procedure of diagnostic x-ray or treatment with reference to the possibility of pregnancy.
I am the Legal Guardian and hereby authorize Furshman & Davis Family chirorpactic to administer care, deemed necessary.