Common Contracts

Please read this agreement carefully BEFORE signing

February 28th, 2011

• Filed
  February 28th, 2011

If you have insurance coverage and wish to bill your insurance company yourself, we ask that you pay 100% of the services rendered to you at the time of each visit. We will provide you with a receipt of payment, the necessary billing information needed, which you can send to your insurance carrier for your reimbursement. If you have insurance coverage and request our office to bill your insurance company, it is the policy of this office that you pay for your first visit in full at the time of the first office visit. If you have health insurance that you believe may cover chiropractic care, this office will verify your insurance coverage for you. Verification of your insurance benefits is not a guarantee that your insurance will pay or should pay. You are fully responsible for the charges incurred for the office visit. Once your eligibility and coverage is determined, we will file all insurance claims for you to the extent that your policy permits. Due to the Federal law, it is illegal