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Your First Chiropractic Visit

New Patient (13 years +)

New Patient (birth – 12 years)

Only fill out if being seen for an auto injury

Your First Functional Medicine Visit

New Patient (must complete prior to first appointment)

New Patient (must complete prior to first appointment)

Neuro-Deflective Disorders 


Please Note: Our office does not determine your chiropractic benefits

Our relationship is ultimately with you and not your insurance company. Your health insurance is a contract between your employer and the insurance company. The percentage covered for each procedure is determined by how much your employer has paid for coverage. We will request information prior to your initial visit for our files and have guidance on how to collect payment.

We offer a very affordable “Time of Service Plan” for those who choose not to utilize their insurance, have a high deductible plan, or do not have chiropractic benefits. Details of our Time of Service Plan are included in the Chiropractic Adult Intake Form.

For your convenience, we accept cash, personal checks and most major credit cards.