Please use the following links to print and fill out our insurance coverage and patient health history forms.
Patient Forms
The forms are in the PDF format; in order to view them you will need a PDF viewer such as Adobe Reader.
If you do not have Adobe Reader you can click below to download it FREE.
Click here to download it.
Insurance and Billing
We accept most traditional insurance plans, but please contact our office to verify acceptance of your plan. We are happy to file insurance for your reimbursement as long as you are free to choose your own doctor.
Patients Without Insurance
An increasing number of patients do not have insurance, or have plans with limited coverage, such as catastrophic policies. We realize that no one wants to build up a large bill. Therefore, we have several plans so those patients may receive complete care without undue financial difficulty.
On-the-Job Injuries (Worker’s Compensation)
If you are injured on the job, your care should be paid for under your employer’s Worker’s Compensation insurance. You will need to inform your employer of the accident and obtain the name and address of the carrier of their insurance. If your employer does not provide us with this information, if a settlement has not been made within 3 months, or if you suspend or terminate care, any fees and services are due immediately.
Personal Injury/Automobile Accidents
Please notify your auto insurance carrier of your visit to our office immediately. Notify our insurance department immediately if an attorney is representing you. Although you are ultimately responsible for your bill, we will wait for settlement of your claim for up to six months after your care is completed. Once the claim is settled or if you suspend or terminate care, any fees for services are due immediately.
Call Us With Your Questions.
Call or text us at (434) 978-4888 with your questions about payment and insurance, or click here to contact us.