New Patient Registration Form

Please download and fill out my New Patient Registration Form before your initial examination and consultation. Please bring the completed form to your first appointment.

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Insurance

I am not in-network for any insurance company and do not submit insurance claims. I do provide a Super Bill receipt with the appropriate insurance codes so that you can easily submit to your insurance for reimbursement.

 

Please take a moment to call your insurance provider or check their website for information about your particular plan's Out-of-Network Chiropractic coverage as well as any diagnosis that is excluded so that you are familiar with your plan's coverage in advance. As I am not a provider with Medicare or American Specialty Health, I do not provide specialized reports or narratives that they might require, so please familiarize yourself with their requirements and restrictions.

 

Cancellation / Rescheduling Policy

I understand there are times you must change or cancel your appointments. My practice requires a 48-hour advance notice.

 

Your timely notice allows me the opportunity to offer your appointment to another patient. In this case, you will not be charged any fee. However, for appointments canceled or rescheduled with less than 48-hour notice, no matter the reason, you will be charged for the full visit fee.

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I look forward to meeting you and working with you on your health!