New Patient Information
WELCOME!
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 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.
Sincerely,
Dr. Keller and staff
To save time please print and fill out the following
before you come in:
New
Patient Information
Health
History
Health Questionnaire
You may also review our financial policies by clicking
here.
