The following is an explanation of our office policies. We believe that a clear understanding will allow us both to concentrate on the most important issues; regaining and maintaining your health. We will be happy to answer any questions you may have regarding our policies, your account or insurance coverage

Complimentary Consultation: Natural Way Chiropractic will conduct a special “no charge” consultation, or brief conference, with anyone interested in finding out if chiropractic can help them with their individual health problem. There is no charge or obligation in connection with this appointment.

Patient Payment Policy: We feel the patient’s health needs are paramount. Therefore, the following Patient Care Services policy is an attempt to allow you, the patient, to receive the care you need and clear your balance with the least amount of difficulty.

Patient Care Services: Payment in full for all services is due at the time of service unless other arrangements have been made. Payment arrangements may be made with the office and payments must be made no less than monthly. Please understand that all services rendered to you are charged directly to you and you are responsible for payment, regardless of your insurance coverage. Properly documented Worker’s Compensation and auto accident claims are not required to pay at the time of service if appropriate forms and liens are signed.

Our Policy on Health Insurance: Many insurance policies cover chiropractic care. We will be happy to file your insurance claim for you and do everything we can to ensure you receive reimbursement. However, we cannot take responsibility for what your health insurance will or will not cover. It is important that you understand that health and accident insurance policies are an arrangement between an insurance carrier and you, the patient, their insured. Of course, Natural Way Chiropractic will prepare any necessary reports and forms to assist you in collecting from your insurance company. Furthermore, any amount authorized to be paid directly to Natural Way Chiropractic will be credited to your account upon receipt.

Appointments: Our office sends email and text appointment reminders, however, they are a courtesy only and not to be relied on. Please call our office as soon as possible if you are not going to make your scheduled appointment. To better serve our patients, we ask that you call if you are unable to make your appointment or if you are running late. Your appointment time is reserved for you. If you fail to notify our office, it leaves a time slot open that could be used to help someone else. For massage therapy services, our office has no show/late cancellation fees if we fail to receive 24 hours notice prior to your appointment as well as late arrival/early departure fees. Fees are dependent on the service and length of time you were scheduled.

Identification Policy: Natural Way Chiropractic requires a copy of photo identification (ex: driver’s license, passport, student ID) to be on file in order to receive care. Also, we require an electronic photo be taken and placed into your medical chart for verification purposes.

Questions and Answers: Your questions about any aspect of your care or account are invited. Please feel free to ask the Doctor or any available staff member. We will make every effort to answer and address your concerns.

Additional Disclosure Authority

In addition to the allowable disclosures described in "Notice of Privacy Practices", I hereby specifically authorize disclosure of my protected health care information to the person indicated below.

We keep a record of the health care services we provide you. You may ask to see and copy that record. You may also ask to correct that record. We will not disclose your record to others unless you direct us to do so or unless the law authorizes or compels us to do so. You may see your record or get more information about it by contacting Natural Way Chiropractic.

Our Notice of Privacy Practices describes in more detail how your health information may be used and disclosed, and how you can access your information.

To Our Patients:

Chiropractic examination and therapeutic procedures (including spinal adjustment, cold application, and manual muscle therapy) are considered safe and effective methods of care. Any procedure intended to help may have complications. While the chances of experiencing complications are very small, it is the practice of this clinic to inform our patients about them. Side effects include, but are not limited to soreness, inflammation, soft tissue injury, dizziness, burns, and temporary worsening of symptoms. More serious complications are extremely rare and their association with spinal adjustments (manipulation) is debated. These complications include injury to the arteries in the neck which may be associated with stroke and serious neurologic impairment, injuries to the spinal discs and spinal fractures.

Therapeutic procedures (including massage therapy, cold application, and heat application) are considered safe and effective methods of care. Draping will always be utilized, and only the body part being worked on will be exposed if necessary. Any procedure intended to help may have complications. While the chances of experiencing complications are very small, it is the practice of this clinic to inform our patients about them. Side effects include, but are not limited to: soreness, inflammation, soft tissue injury, dizziness, burns, and temporary worsening of symptoms.

I understand it is my responsibility to let my massage therapist know of any pain or discomfort I am having during the session, or if I’d like the pressure to be less or more at any time. I have also notified my massage therapist of all known medical conditions and injuries. I also understand this is a doctor’s office and that my massage is entirely therapeutic and non-sexual in nature.

I understand that my insurance company may deny payment for the service provided to you for the following reasons:

That the particular services is not reasonable and necessary under my insurance companies standards.

For this reason, please read and sign the following statement:

"I have been informed by my physician that they believe that, in my particular case, my insurance may deny payment for the service identified above, for the reason stated. If my insurance denies payment I agree to be personally responsible for payment of said services."

Explanation of benefits disclaimer

I, the undersigned patient, completely understand that Natural Way Chiropractic provides insurance billing and insurance benefit verification as a courtesy to the patients. I understand that the service Natural Way Chiropractic provides for verification of insurance coverage is in no way a promise of payment by my insurance company. If my insurance company denies my claim(s) for any reason, or misquotes my benefits to Natural Way Chiropractic, the balance of my account will be billed to me and due to the clinic.

It is the policy of Natural Way Chiropractic to never enter into a dispute with your insurance company for any reason.

I, the undersigned patient, completely understand the insurance services provided to me regarding my insurance coverage as stated above. I understand that my signature below serves as a "signature on file" to bill the above insurance company and allows this clinic to accept assignment of insurance benefits. I understand the above "Benefits Disclaimer" and my financial responsibilities to any services rendered by this clinic.

I understand that Natural Way Chiropractic, PS may have a contact with my insurance company that allows only co-pays to be collected at time of service. By signing this form, I am agreeing to pay any co-pay, deductible and coinsurance at time of service. This may offer a reduced fee for paying at the time of service rendered.

Describe the Moment of Impact

After the Accident