Patient Forms and Insurance

Please use the links to the right to print and fill out our insurance coverage and patient health history forms. You have the option to print all forms at one time or each individual form. The forms are formatted in Adobe Acrobat, in order to view them you will need Adobe Reader installed on your computer. If you do not have Adobe Reader you can click here to download it FREE.

adobe reader

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 insurance clerk has years of experience and will be happy to assist 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. Of course we are always happy to accept cash, your personal check, MasterCard, Visa or Discover cards.

Forms


Chiropractic Forms

Dr. 10's's Acupuncture Forms

Dr. Sanders's Acupuncture Forms

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.