Patient FORMS

Please print and completely fill out all pages of the patient forms below, and bring them to your appointment.

New Patient Forms

Bring the new patient forms with you on your first visit along with any x-rays, CT scans or MRI’s that you may have. Please also bring a complete list of any medications or supplements that you are currently taking. Your first visit will take an hour and consists of a patient history, exam, and adjustment. Subsequent visits are scheduled to take about 15 minutes.

Returning Patient Forms

If you are returning for after an absence of one year or more, please bring the returning patient forms to your next appointment with any updated x-rays, CT scans or MRI’s that you may have. Please also bring an updated list of any medications or supplements that you are currently taking. Returning patient visits are scheduled to take about 15 minutes.

Medicare Form

We accept most insurance that covers chiropractic, including Medicare. If you are using Medicare please print and complete the form below and bring it with you to your next appointment.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises.