To make your visit more efficient please
print out and fill in the following information.
As of January 1, 2012:
We WILL NOT participate with insurance companies other than MediCare, Bravo, or Tricare.
Please contact your insurance company to determine what you may submit for reimbusement. The cost of your visit is due at the time of service. We do not see workman’s comp or accident cases.
click on each link to save or download the form
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Forms - ALL
9 pages - 2.7 mb (pdf document)
316 k (pdf document)
260 k (pdf document)
& Headache Info
288 k (pdf document)