If you are a new patient, please download, print and complete the following form.
Each insurance company has their own, distinct amount for their fees. Your fee will be based off of the treatments used and the duration of your visit. If your insurance doesn’t cover chiropractic care, we offer cash fees.
If you will be billing your insurance, please bring a copy of your insurance card on the first visit. If you have any questions, please contact us at firstname.lastname@example.org and will get back to as fast as possible.
For all worker’s compensation claims, please bring your claim number, name of the adjustor and any documentation you may have from a referring doctor.
Motor Vehicle Accident (MVA)
You all patients that are being treated for a MVA, please bring the name of your insurance & claim number, the other persons insurance company (if applicable), name of your claim adjustor & phone number, and name and contact info for your attorney (if applicable).