Forms

For your first visit please bring some loose fitting gym shorts and for females please bring a sports bra to change into if your first meeting continues to the point of an examination.

If you would like to save time on your first appointment, please print, complete and bring the following forms with you:

• Financial Policy Form
• Patient Entrance Form
• Patient HIPPA Form
• Credit Guarantee Form

Chiropractic care is affordable. We are concerned about the cost of healthcare, and our goal is to provide excellent care at a reasonable cost. We also have various payment plans available and accept Visa, MasterCard, American Express, and Discover. We accept most insurance, personal injury, Medicare and Workman’s Compensation.

• Insurance Assignment of Benefits

If you are bringing your child, age 5 years or younger, for an assessment or treatment, please print, complete and bring the following forms with you:

• Patient Pediatric Consent Form
• Patient Pediatric Entrance Form

If you have been involved in an Automobile Accident, please print, complete and bring the following form with you, as well as the forms above.

• Auto Accident Form
• Pain Questionaire (Low Back)
• Pain Questionaire (Neck)

All our forms are provided in the “pdf” format.  If your computer is unable to open them, you can download a free pdf reader from Adobe by clicking here.