SAVE TIME NOW....
Forms are available for download and printing.
WE OFFER AFFORDABLE CARE PLANS FOR INDIVIDUALS AND FAMILIES.
Please call our office so we can give you our
NEW PATIENT special rates: (310) 399-0337
You
need Adobe Reader to view and print these files.
Click here for Adobe
Reader.
ALL
NEW PATIENTS...
Review options 1-5 below and print the forms you will need.
#1
- HEALTH INSURANCE (Click
HERE for forms)
If
you have health insurance that covers Chiropractic care, we will bill
your insurance directly and expect to be reimbursed by your insurance
company. Please be aware that payment from your insurance company cannot
be guaranteed, and benefits are not determined until your claim is processed.
Until we have the completed, necessary insurance information to verify
chiropractic coverage, you will be required to pay for your care. Our
staff will collect any applicable deductible, co-payments, and any charge
for non-covered services from you at the time of service. In the event
the check should come to you, you are expected to bring the check to us.
Most ordinary "health" policies are designed and intended
to only take care of acute problems. Extended care in our office is available
at affordable rates despite whether your insurance covers it or not.
#2
- MEDICARE (Click
HERE for forms)
There is a $135 yearly deductible to meet, required
by Medicare. Most Medicare patients have a secondary PPO insurance that
picks up the balance of what Medicare does not pay. As we are not a Medi-cal
provider, if you have Medi-cal or do not have a secondary PPO insurance,
then you are responsible for a nominal co-payment for each visit that
is covered by Medicare.
#3
- CASH PATIENT (Click
HERE for forms)
Fees are discounted to $50 per visit after the initial visit. We can work
with you visit by visit, however it may be more economical to consider
our Wellness Program. If you decide to participate in our Wellness Program,
the doctor will design a personalized regimen for you, which consists
of weekly visits (2-3 per week), metabolic nutritional recommendations,
re-evaluations and x-ray reviews. Necessary x-rays and nutritional supplements
are not included. Our 12-week Wellness Program is $1050 paid fully in
advance and is non-transferable. Any refund is based on the cash discount
fee of $50 per visit.
#4
PEDIATRIC PATIENT (Click
HERE for forms)
#5
AUTO/PERSONAL INJURY (Click
HERE for forms)
Auto Accidents, Slips and Falls, and Trauma outside of the work environment.
You need to supply us with a copy of your : 1) Driver's license,
2) your Auto Insurance Declaration Page, 3) your Auto Insurance Claim
Number, medical adjustor's name & phone # , 4) your Health Insurance
card, 5) Liable parties' Auto Insurance information, 6) Police report,
if any, & 7) Attorney name & phone #, if any. We will bill your
insurance directly after verification of coverage. In the event that the
check should come to you, you are expected to bring the check to us. Most
patients have either Medical Payments coverage or an attorney or both.
The doctor will discuss the lien arrangements between all parties on your
second visit.
If
you have an ATTORNEY for this injury please
complete THESE ADDITIONAL
FORMS
Please
print out the forms and bring them into our office on your first visit.
You are also welcome to fax them back to us, FAX: 310-399-3944 so we can
be better prepared to serve you when you arrive.
|