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Practice Name

Day Chiropractic

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Primary Location
3758 SE 122nd Avenue
Portland, OR 97236
Phone: 503-760-7572
Fax: 503-760-7567

Office Hours

DayMorningsAfternoon
Monday7:30 - 11:00 am2:30 - 6:00 pm
Tuesday7:30 - 11:00 am2:30 - 6:00 pm
WednesdayEmergencies
Thursday7:30 - 11:00 am2:30 - 6:00 pm
FridayEmergenciesEmergencies
Saturday9:00 - 10:00 amEmergencies
SundayClosed
Main Content

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

Patient Data

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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 __________________________________

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Medical History

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Family History

Habits

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Marcos Video

Miscellaneous

Prime CD


Go to I-tunes to download
Go to CD Baby to download or
Come by our office Dr. Day and his brothers LOVE playing bluegrass together, and we hope that you will enjoy the music on the inaugeral CD. Dr. David Day wrote 2 of the songs on this album, the first is the title track "I'm not Fat, I'm Prime" and the "Stillaguamish River Waltz" in honor of river that ran next to the town where he was raised.

The Cure & Parents

Clothing Drive

President of Midway Business Association

Dr. David A. Day is the president of the Midway Business Association.  If you own a business in SE Portland between I-205 and Gresham, and between Stark and Foster, give our office a call at 503/760-7572.  Our monthly meeting is the 2nd Tuesday of each month at Pizza Baron (SE 122nd and Division) at Noon.  When you join, you will get a free listing on our website at www.MidwayBusiness.org.  Our Facebook page is facebook.com/MidwayBusinessAssociation

Office Hours

DayMorningsAfternoon
Monday7:30 - 11:00 am2:30 - 6:00 pm
Tuesday7:30 - 11:00 am2:30 - 6:00 pm
WednesdayEmergencies
Thursday7:30 - 11:00 am2:30 - 6:00 pm
FridayEmergenciesEmergencies
Saturday9:00 - 10:00 amEmergencies
SundayClosed


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