- Click on the link to download
- Save the PDF to your computer
- Fill out the form on your computer and resave
- Attach completed PDF to an email and send before your appointment OR print out and bring with you to your appointment
For all new patients/returning after 3+ years:
For those with Medica/UnitedHealthCare:
For new massage patients:
- Massage Intake
Email completed paperwork to doctor@edinachiropractic.com
**If you do not have AdobeReader® installed on your computer, Click Here to download.
In addition to the patient forms above, please remember to bring the following with you to your appointment:
- Insurance card(s)
- Photo ID
- Referrals (if required)
- Co-payments
Insurance
Please verify we are an in-network provider with your insurance prior to your appointment. You must bring your current insurance card and be prepared to make your co-payment at the time of your visit. If you are unsure what your chiropractic coverage entails, please call the number on the back of your insurance card.
If you’re being seen for a motor vehicle accident or workers’ compensation injury, you’ll need the assigned claim number.
If you have no health insurance or do not have your insurance information at the time of your visit, please be prepared to make the required payment toward your initial visit. Payment arrangements for subsequent charges can be made with the billing department.