Printable Office Forms
Complete Health Chiropractic’s fee schedule is based on usual and customary fees for the type of service provided.Generally, your insurance policy will cover a portion of the services provided.
Please note: There is no guarantee of payment. Should your insurance carrier deny payment, the total uncovered balance will be transferred to personal pay and will be your responsibility. You are responsible for any deductible, co-pays, co-insurance or ineligible charges.
Monthly statements will be sent to you advising you of the status of your account. Payment of your portion of the services, as outlined on the monthly statement under the: Due From Patient”, column must be paid within 30 days of the receipt of the statement. If balance is not received within 30 days, there will be a 5% interest fee applied, along with any collection fees.
Office Forms:
Chiropractic Intake Form
HIPPA Policy
Massage Intake Form
Patient Payment Policy
Colonic Intake Form