Our Patient Forms
Please use the following links to print and fill out our insurance coverage and patient health history forms. The forms are in the PDF format; in order to view them you will need a PDF viewer such as Adobe Reader. If you do not have Adobe 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'll 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 90 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 you financial responsibilities at our office, please do not hesitate to ask. Our insurance clerk 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. We realize that no one wants to build up a large bill. 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, MasterCard, Visa, Discover cards or CareCredit. We also offer several different financing options outside of our clinic.
"ON THE JOB" INJURY (Worker’s Compensation)
Our clinic does NOT accept Worker's Compensation claims/benefits at this time.
PERSONAL INJURY OR AUTOMOBILE ACCIDENTS
Please notify your auto insurance carrier of your visit to our office immediately. Notify our insurance department immediately if an attorney is representing you, as we only accept Letters of Representation from specific attorneys; subject to approval and change. In most cases, we will file on your Personal Injury Protection (PIP) Policy during the course of your chiropractic treatement. If you have any questions, need more information or clarification, please contact us (903.465.1881)
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 pays 80% of the allowable fee once the deductible has been met. You are required to pay the deductible and the remaining 20% as well as any non-covered services. Our office completes and files the forms for 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.
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Patient Forms
