New Patient Registration

Please complete this form so that we understand your history and your current health. You may also leave any questions, comments, or long-term goals that you have for your continued vision health.

INTRODUCTION PDF

HIPAA Release Form

Please fill out this form to disclose your personal information. This information may be used for medical treatment or consultation or for billing purposes or at the
request of the individual.

PATIENT HISTORY PDF

Insurance Information

We have partnered with a variety of insurance carriers. If you are unsure if your healthcare plan covers chiropractic and acupuncture care, please call our office.

Payment Plans

If your healthcare plan does not fully cover chiropractic and acupuncture care, we are also more than happy to discuss payment plans.

712-943-3081