Patient Forms, Insurance Information and Payment Options:

We offer our paperwork online so you can complete it in the convenience of your own home.

Chiropractic Care

We offer our paperwork on line so you can complete it in the convenience of your own home. These are the forms required for your chiropractic appointment as a new patient or if you haven't been in recently. Our staff can advise returning patients on which forms to update.

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Accident/Injury

If your visit is due to a recent accident or injury, we need some additional information and ask that you complete this form.

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Massage Therapy

This lets us know if there are any special concerns, but perhaps more important, where do you want to take your health? We offer our paperwork online so you can complete it in the convenience of your own home. If you have questions about these forms and which ones you should complete, please call our office at (320)203-8266 and our staff will guide you.

Download & Print Form

Free AdobeReader®

Each form is a PDF document file. If you do not already have AdobeReader® installed on your computer, click the Adobe® image to download for free.

Insurance Information and Payment Options:

Group or Individual Insurance:

We are a network provider for most insurance programs, and we will assist you in any way we can to make the insurance system understandable 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. We will file your claim and await payment for 30-60 days. If your company pays the benefits they quote to us, the only services you will be responsible for are any non-covered services, deductibles or co-pays. If you have any questions at all regarding your financial responsibilities at our office, please do not hesitate to ask. Our insurance manager will be happy to assist you.

Patients Without Insurance:

An increasing number of patients do not have insurance or have plans with high deductibles, such as Health Savings Accounts (HSA’s) or other more limited policies. We realize that no one wants to build up a large bill. Therefore, we have several plans that offer a time of service discount, or a family program, so that you and your family may receive complete care without undue financial difficulty. Of course we are always happy to accept cash, your personal check, MasterCard or Visa cards.

“On the Job” Injury (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 have the right to treat the injury at the clinic of your choice; however, you may have to have an initial exam at a clinic designated by your company. You will need to inform your employer of the accident and obtain the name and address of the carrier of their insurance. You generally receive twelve weeks of care with a work injury.

Personal Injury or Automobile Accidents:

If you are involved in a car collision, it is important that you have an evaluation for possible injuries. Even a small collision (5 mph) can cause long-term damage to ligaments and joints. Our team of specialists will complete a comprehensive evaluation and develop a treatment plan for you. Your auto insurance covers treatment costs and you do not need a medical referral to use Chiropractic services. We will work with your insurance company and your attorney. When you come in for treatment from an auto injury, make sure you have your claim number and insurance card. We will also coordinate any referrals that you may need during your treatment.

Medicare:

We do accept assignment from Medicare. The check is usually sent directly to our office in payment of the services that Medicare will cover, which for Chiropractors is only manual manipulation of the spine. Medicare programs vary and we will assist you in checking benefits. You will be informed if there are fees that you must pay for exams or therapies. Our office completes and files the forms for Medicare at no charge.