Applied Kinesiology
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NEW PATIENT FORMS

If you are a new patient at our office, we will need information about you on your first visit. In an effort to allow you the necessary time to fill out the required paperwork, the forms can be mailed or faxed to you upon scheduling your initial visit, or you may choose to download, print, and complete the following forms. Please bring the forms with you on your initial visit. It is not necessary to mail or fax them back to us.

NEW PATIENT INFORMATION

INFORMED CONSENT TO CHIROPRACTIC TREATMENT

HIPAA PRIVACY POLICY

Please be advised that full payment is due at the time services are rendered. We are not contracted with any insurance companies, but will provide you with a statement that you may file with your carrier. Most insurance companies provide chiropractic coverage. If you are unsure about your benefits, you may call the number on the back of your insurance card to verify out-of-network chiropractic coverage.

MEDICARE ONLY:
We are nonparticipating Medicare providers. Full payment is due at the time services are rendered. We will file Medicare claims requesting that reimbursement be sent directly to you, but please be advised that Medicare reimbursement for our services is limited. You will be asked to sign a Medicare form on your first visit detailing this information. You may discuss any Medicare concerns with the receptionist.