Your First Chiropractic Visit
New Patient (birth – 12 years)
New Patient (13 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
Additional Forms
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 before your initial visit for our files and have guidance on collecting 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. Our Time of Service Plan details is included in the Chiropractic Adult Intake Form.
We accept cash, personal checks, and most major credit cards for your convenience.