Please use the following links to print and fill out our insurance coverage and patient health history forms. The forms are in the PDF format; in order to view them you will need a PDF viewer such as Adobe Reader. If you do not have Adobe Reader you can click the following button to download it FREE.

As a service to our patients, we are pleased to offer the CareCredit card, the nation's leading patient payment program. With CareCredit you can finance 100% of your chiropractic care and there are no upfront costs, no annual fees, and no pre-payment penalties. So, you can begin your treatment today and conveniently pay with low, monthly payments.

CareCredit offers a full range of payment plans so you can find one that works best for you. With the popular No Interest Payment Plans* there are no interest charges if you pay your balance in full within the specified time period. Monthly payments can be as low as 3% of your balance. For procedure fees from $1,000 and up, CareCredit offers 24, 36, or 48 month plan options with low monthly payments available.

CareCredit can be used by the whole family for ongoing treatment without having to reapply. And by using CareCredit for your chiropractic care, you can save your other credit cards for household or unplanned expenses. It only takes a few minutes to apply for CareCredit and you'll receive an online decision in seconds! Apply Now or see our staff for more details.

* terms and conditions

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.

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

PERSONAL INJURY OR AUTOMOBILE ACCIDENTS
Please notify your auto insurance carrier of your visit to our office immediately. Notify our insurance department 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.

MEDICARE
We do not accept assignment from Medicare. This means you will pay us for all services rendered and Medicare will send any reimbursement checks directly to you the patient. Medicare reimburses for only manual manipulation of the spine. They pay 80% of the allowable fee once the deductible has been met. All other services are NON-COVERED. These services include but are not limited too: x-rays, examinations, extremity adjustments, rehab, nutrition and supports. Medicare patients are fully responsible for all covered and non-covered services. Secondary insurance may or may not pay for these non-covered services so be sure to present your secondary insurance card to the front desk. Our office will complete and file your claims with Medicare.

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