Please use the follow links to fill out our insurance coverage and patient health history forms.

Neck Disability Index

Low Back Questionnaire

New Patient Information Form


Group or Individual Insurance

We attempt to take out as much of the “insurance hassle” as possible for you. We’ll be happy to contact your insurance company and 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 insurance pays the benefits they quote to us, the only services you will be responsible for are any non-covered services, deductibles, and co-pays. If you have any questions at all regarding your 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. We realize that no one wants to build up a large bill. Therefore, we have several plans so that those patients can receive complete care without undue financial difficulty. Of course, we are always able to accept cash, personal checks, MasterCard, Visa, or Discover cards.


“On the Job” Injury (Worker’s Compensation)

If you are injured on the job, your care should be paid for through your employer’s Worker’s Compensation insurance. You will need to inform your employer of the accident and obtain the name and address of their insurance. If your employer does not provide us with that information, if a settlement has not been made within 3 months, or if you suspend or terminate care, any due fees for services will be due immediately.


Personal Injury or Automobile Accidents

Please notify your automotive insurance carrier of your visit to our office immediately. Notify our insurance clerk immediately if an attorney is representing you. Although you are ultimately responsible for your bill, we will wait for settlement of your claim for up to six months after your care is completed. Once the claim is settled, or if you suspend or terminate care, any fees for services are due immediately.


We do accept assignment from MEDICARE. The check is usually sent directly to our office in payment for 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 if you have any secondary insurance. We will assist you if you need help filing.