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ALL NEW PATIENTS...
Review options 1- 3 below and print the forms you will need.
Please phone our office for our fees and to pre-verify your insurance coverage before you come in. We are happy to work with all PPO and POS plans and Med-Pay/PIP on your Auto Policy if this visit is due to an auto injury. We only work with auto injuries and not slip/fall cases.
Note: We do not participate with Medi-care , Medi-cal and Worker's Compensation cases.
Please read carefully and choose the plan which you prefer. This information will enable us to better serve you and help avoid misunderstandings in the future. If special arrangements are necessary please consult with the Doctor. Our main concern is your health and well-being, and we will do the best to help you!
PLAN #2 CASH AGREEMENT: (Click HERE for forms) Fees are discounted 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.
PLAN #3 AUTO INJURY: (Click HERE for forms) We do not work with slips and falls, only auto accidents. We can refer you to an attorney if you have a slip or fall case. For auto injuries: 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. Our preference is to work with specific attorneys who only work with Auto Injuries or Personal Injury cases. Before you sign up with an attorney, please consult with our office for our excellent referrals.
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.
Neighborhood Chiropractor Serving the Communities of Santa