For Patients

Forms

Commercial Insurance Paperwork

Please select commercial insurance paperwork if you have Aetna, Blue Cross & Blue Shield, Humana, United Health Care. We do not accept HMO Plans.

Medicare Insurance Paperwork

Please select Medicare Insurance only if you have Medicare Part B Insurance - Do not fill out the commercial insurance paperwork if you have a secondary insurance in addition.

Workers Compensation Paperwork

Please select workers compenstation if you are a workers compensation case - Please note we will not schedule appointments until approval from your case manager is received.

Motor Vehicle Accident & Self Pay Paperwork

Please select motor vehicle accident & self-pay if you have been in a motor vehicle accident or choose to not bill insurance and be self-pay.  We do not bill any third party motor vehicle insurances and request payment at time of service.  Our self pay rate is $120.00 per visit.

Credit Card Policy

Our Credit Card Policy is required for ALL patients.