Please use the following links to print and fill out our patient health history forms. The forms are formatted in Adobe Acrobat, in order to view them you will need Adobe Acrobat Reader installed on your computer. If you do not have Adobe Acrobat Reader you can click the link below to download it FREE.
NEW PATIENT FORMS
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 60 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 will be happy to assist you.
INSURANCES THE CLINIC DOES NOT ACCCEPT
The clinic does not accept the following insurances due to the fact that their copay is usually more expensive than our cash price: Medicaid or any of it's forms (Molina, Meridian, Blue Cross Complete, etc), Priority Health, United Healthcare, or any HMO (Blue Care Network, HAP, etc).
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 only charge $40.00/visit. Of course we are always happy to accept cash, your personal check, and credit or debit cards (HSA and FSA included).
PERSONAL INJURY OR AUTOMOBILE ACCIDENTS
We currently do not accept personal injury or automobile cases. If one wishes to seek care at the clinic, they will be treated as a patient without insurance, and after treatment has completed, they will be furnished an itemized bill that they can try to submit to their insurance for reimbursement.