(Don’t forget to SCROLL all the way down ⇓ to the bottom of the page and print and fill out ALL new patient forms, 4 TOTAL)
(click on form ⇑ to print)
Welcome Sheet (2-sided)
Popovich Chiropractic’s Welcome Sheet is used during your visit to let the Doctor know about your condition and any potentially related health problems that might interfere with your treatment.
Sign In Sheet (2-sided)
(Click on form to print)
Popovich Chiropractic’s sign in sheet to be used during your visit. This sheet is used to help determine your pains and how they can best be treated. Back page of Sign in Sheet for Doctor’s use only.
Financial policy
Insurance patients Note: SOME DEDUCTIBLES DON’T APPLY TO CHIROPRACTIC SERVICES, and in those instances you would ONLY owe your co-pay. Also, SOME insurance policies cover the new patient exam even if they have a deductible that isn’t met, so the out of pocket cost under those plans for the first visit would generally only be around $74 instead of the $159.
(Click on form to print)
Cancellation and No Show Policy
(Click on form to print)
Time of Service Discount
(For Uninsured or Cash Patients Only). Our cash prices are roughly the same as the AVERAGE amount we’re paid by insurance companies minus a few dollars saved on billing costs. This makes it FAIR to EVERYONE.
(Click on form to print)