Book your Consultation and with Dr. Brian Leiberman at Leiberman Family Chiropractic$125 - Paid in office upon arrival Name * First Name Last Name Email * Phone * (###) ### #### What is your chief complaint? * (Select all that apply) Joint Pain Weight Loss Neuropothy Something Else Tell us more about your chief complaint: (Optional) How open are you to cash pay services? I am ready to self pay if need be. Im open to self pay but wants to use insurance also I only want to use insurance. How Committed are you to receiving care? * Very Committed Somewhat Committed Neutral Not Committed at all Preferred Appointment Date MM DD YYYY Preferred Appointment Time 10am 11am 1pm 2pm 4pm i might need later Thank you for booking your appointment with Dr. Sunny Gill at Rome Spine and WellnessA member of the Rome Spine and Wellness staff will contact you within 24 hours to confirm your appointment with you.Rome Spine and Wellness706-842-7215www.Romespineandwellness.com