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New Patient Forms

We offer our paperwork online so you can complete it in the convenience of your own home.

Health History

This lets us know what’s happened, but perhaps more important, where do you want to take your health?

Wellness Centers Initial Paperwork

Automobile Accident

If your health issue is the result of a car accident, we need some additional information.

Wellness Centers Personal Injury Paperwork (only if seeking treatment due to an auto accident, if not please use above link for initial paperwork)

Release of Records

If you have received chiropractic care elsewhere, or have medical records we will need from another practitioner, please sign this release.

Authorization for the Release of Medical Records

General Insurance Information

GROUP OR INDIVIDUAL INSURANCE
We attempt to take out as much of the “insurance hassle” as possible for you. We’ll happily telephone your insurance company to verify your coverage benefits. Please remember, however, that the benefits quoted to us by your insurance company are not a guarantee of payment. We will file your claim and await payment for 90 days. If your company pays the benefits they quote to us, the only services you will be responsible for are any non-covered services, deductibles or co-pays. If you have any questions at all regarding you financial responsibilities at our office, please do not hesitate to ask. Our team has years of experience and will be happy to help you.

PATIENTS WITHOUT INSURANCE
An increasing number of patients do not have insurance, or have plans with limited coverage, such as catastrophic policies. We realize that no one wants to build up a large bill. Therefore, we have several plans so those patients may receive complete care without undue financial difficulty including ChiroHealthUSA a chiropractic discount plan. Of course we are always happy to accept cash, your personal check, MasterCard, Visa or Discover cards.

PERSONAL INJURY OR AUTOMOBILE ACCIDENTS
Please notify your auto insurance carrier of your visit to our office immediately. Notify our insurance department immediately if an attorney is representing you. Although you are ultimately responsible for your bill, we will wait for settlement of your claim for up to six months after your care is completed. Once the claim is settled or if you suspend or terminate care, any fees for services are due immediately.

MEDICARE
We do accept assignment from Medicare. The check is usually sent directly to our office in payment of the services that Medicare will cover, which for Chiropractors is ONLY manual manipulation of the spine. Medicare pays 80% of the allowable fee once the deductible has been met. You are required to pay the deductible and the remaining 20% as well as any non-covered services. Our office completes and files the forms for Medicare at no charge.

SECONDARY INSURANCE
Please inform us of any secondary insurance you may have. We will assist you if you need help in filing.

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