New Patient Entrance Form

Please use the following link to print and fill out our New Patient 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 here to download it FREE.

GROUP OR INDIVIDUAL INSURANCE

We attempt to take out as much of the "insurance hassle" as possible for you. We will 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. If we are a Participating Provider for your insurance company, we will file your claim and the only services you will be responsible for are any non-covered services, deductibles or co-pays which will be due at the time of service. All financial information and responsibilities will be explained to you before treatment is rendered.  If you have any questions at all regarding your financial responsibilities at our office, please do not hesitate to ask. Our staff has years of experience and will be happy to assist you.

PATIENTS WITHOUT INSURANCE

An increasing number of patients do not have insurance, or have plans with limited coverage, such as catastrophic policies.  Therefore, we have several plans so those patients may receive complete care without undue financial difficulty. Of course we are always happy to accept cash, your personal check, Visa, MasterCard, American Express, or Discover credit cards.

WORKER'S COMPENSATION

If you are injured on the job, your care should be paid for under your employer’s Worker’s Compensation insurance. You will need to inform your employer of the accident and obtain the name and address of the carrier of their insurance.  We will verify coverage and make all the arrangements necessary to begin treatment.

PERSONAL INJURY OR AUTOMOBILE ACCIDENTS

Please notify your automobile insurance carrier of your pending visit to our office. Notify our staff immediately if an attorney is representing you so that we may contact their office and coordinate information.

MEDICARE

We accept Medicare patients.  Our office completes and files the forms to Medicare at no charge. 

SECONDARY INSURANCE

Please inform us of any secondary insurance you may have. We will assist you if you need help in filing.