Book your Appointment

Book your appointment online now. Follow these simple steps:

Step 1: Please select the location of your first visit.

Step 2: Choose day and time for your appoitnment:


Step 3: Fill out information:

Full Name:
Date of Birth:
Phone Number:
Address:
E-mail:
Reason for visit:
Have you been seen by a chiropractor before? Yes No

Special Message:
  • Our policy requires payment in full for all services rendered at the time of visit, unless other arrangements have been made with the business manager.
  • I authorize the staff to perform any necessary services needed during diagnosis and treatment. I also authorize the provider and or managed care organization to release any information required to process insurance claims if I am using insurance.
  • CANCELLATION POLICY: We require 24 hours notice of rescheduling or canceling appointments. Our office charges a fee of $35 for any missed appointments.
  • PROMOTIONAL OFFERS: Promotional offers DO NOT INCLUDE medical reports, x-ray reports, borrowing x-rays, and any other services not listed in the offer. If you or another doctor requests these additional services, there may be an additional charge that you are responsible for.
  • Our office complies with HIPPA policy and guidelines. You can view the Hippa form by clicking here. You acknowledge that you have read and understand the HIPPA form.
  • I understand the above information and guarantee this form was completed correctly to the best of my knowledge and understand it is my responsibility to inform this office of any changes to the information I have provided.

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