Chiropractic Care Patient Forms

Please click on the following link to be taken to our New Patient Intake Form. Simply answer the questions, hit the ‘Submit Form’ button and it will be sent directly to our front office staff.

For Ages 13 - up: Click Here for Intake Form

For Ages 3 - 12: Click Here for Intake Form

For Ages 0 - 2: Click Here for Pediatric Intake Form

GROUP OR INDIVIDUAL INSURANCE

We attempt to take out as much of the “insurance hassle” as possible for you. We’ll happily contact 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. 

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. Of course we are always happy to accept cash, your personal check, MasterCard, Visa or Discover cards.

SECONDARY INSURANCE

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