Patient Forms for Diamond Chiropractic Health Center
Please use the following links, as needed, to print, complete and bring with you to your appointment.
Pediatric Intake Form pdf* (71kb)
Adult Intake Form pdf* (64kb)
PATIENTS WITHOUT INSURANCE
An increasing number of patients do not have insurance, or have plans with limited coverage, such as catastrophic policies. We realize that no one wants to build up a large bill. Therefore, we have several plans so those patients may receive complete care without undue financial difficulty. Of course we are always happy to accept cash, your personal check, MasterCard, Visa or Discover cards.
"ON THE JOB" INJURY (Worker's Compensation)
If you are injured on the job, your care should be paid for under your employer's Worker's Compensation insurance. You will need to inform your employer of the accident and obtain the name and address of the carrier of their insurance. If your employer does not provide us with this information, if a settlement has not been made within 3 months, or if you suspend or terminate care, any fees and services are due immediately.
PERSONAL INJURY OR AUTOMOBILE ACCIDENTS
* PDF forms require a PDF Reader such as Adobe Reader