New Patient Information

We are looking forward to seeing you for your first visit to our office. Below are some links to forms that we would like you to complete prior to your visit here. If you have other relevant records, X-rays, or MRIs please bring them with you or bring the provider’s information where the tests were done so that we can send for necessary records. If you have a particularly complicated or extensive health history, feel free to use additional pages. Please bring your completed paperwork with you on your first visit.

Your first visit will last between 45 minutes to an hour, during which we will ask you more detailed questions about your condition, perform an examination and discuss options for care or the need for additional testing.

Treatment may or may not be provided on the first visit depending on the exam findings and the need for additional testing. Be assured that we will do our best to help you with your problem as quickly, effectively and as safely as we can. The vast majority of patients that we see get relief from their condition after just a few visits to the office. If chiropractic care does not seem to be the best treatment for your condition, other options will be discussed. If we cannot help you, we will help you find someone who can.

Full payment is expected at the time of service. Payment can be by check, cash or credit card. The only exceptions are for Workers Compensation and Medicare.

Effective January 1, 2008 Keller Chiropractic is withdrawing from all managed care contracts and will no longer provide insurance billing except for OSU Health Plans, BWC and Medicare. We can provide you with an itemized bill with all the information you need to submit to your insurance company.

Please be aware that insurance companies have varying rules and coverages for specialties like chiropractic. We strongly advise you to contact your insurance company to learn the current benefits for out-of-network chiropractic services.

If your injuries are the result of an automobile accident, please note we do not take assignment for personal injury claims. We require payment at the time of service.

Dr. Keller is a participating provider for Medicare. Medicare has unique rules for chiropractic services. If you have questions please call the office to speak with a staff person and/or get a copy of the Medicare financial policy from our office.

For more complete explanation of our financial policies and fees please click below.

We look forward to seeing you. Please do not hesitate to call us if you have any questions before your visit.


Dr. Keller and staff


To save time please print and fill out the following before you come in:

Patient Information

Health History

Current Health Complaint

To review our financial policies download the file that applies to you.

Keller Chiropractic Financial Policy For Self Pay 2017

Keller Chiropractic Medicare Financial Policy for 2017

You may also review our privacy policies here.

Notice of Privacy and Confidentiality