NEW PATIENT FORMS

PLEASE READ:

    As a new patient, it is very important for us to gain as much valuable information as we can about you, your complaint and your past health history. This information allows us to give you the quality care you want and deserve. Please, take the time to fill out the forms completely and accurately and bring them with you to your first visit. We have the forms in our office if you choose to complete them there. PLEASE COME 15 MINUTES EARLY if you plan on completing paperwork at the clinic. Thank you.

Chiropractic Intake Form
Chief Complaint
Past Health History Form
Informed Consent Form
Financial Policies
***If you have United Healthcare Insurance, please fill out this additional form (Top & Bottom portions ONLY)***
United Healthcare Intake Form

INSURANCE INFORMATION & PAYMENTS

Our clinic accepts most insurance plans. We are currently preferred providers for...

  • Anthem

  • Blue Cross Blue Shield

  • Aetna

  • Cigna

  • United Healthcare

  • UMR

  • Cofinity

  • Humana

  • Medicare

If you insurance provider is not listed, please give us a call to find out what your benefits are. Most plans have chiropractic benefits and if we are Out Of Network, we will stay competitive with your rates! Call us today!

Our Clinic also accepts non-insurance paying patients. We accept major credit cards, cash and personal checks. We offer reduced rates to non-insurance paying patients as there are no fees for filing claims, no follow ups, no appeals.

*PHYSICAL THERAPY * REHABILITATION * MASSAGE THERAPY * FOOT BATH DETOX * DRY NEEDLING * TRACTION * ACUPUNCTURE*

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