New Patient Information & Forms

Dr. Moore is currently a participating provider with Blue Cross Blue Shield, United Healthcare, and Medicare.

INSURANCE PROCEDURE:

Please call the information phone number located on your insurance card for insurance benefits for chiropractic benefits.

Please Click Here For Insurance Coverage Instructions & Additional Insurance Information.

ATTENTION: Please contact the office before filling out these forms.

The 4 forms below can be completed at any time BEFORE your scheduled visit:

The forms below (that you were instructed to fill out) should be completed ON THE DAY of your scheduled visit, so that they will be current.

REMINDER: Bring Insurance Card the Day of your Initial Visit.

 

The following Information should be brought if your case is related to an Auto Accident:

  • Insurance Information (Both Party at Fault and Personal)
  • Claim Number
  • Police/Accident Report
  • Any Emergency Room documents pertaining to incident (If Applicable)
  • Any X-rays, MRI, Radiology, etc. Reports (If Applicable)

 

The following Information should be brought if your case is related to a Personal Injury:

  • Insurance Information (Both Party at Fault and Personal)
  • Claim Number
  • Accident Report (if any)
  • Any Emergency Room documents pertaining to incident (If Applicable)
  • Any X-rays, MRI, Radiology, etc. Reports (If Applicable)

 

The following Information should be brought if your case is related to a Workers Compensation:

  • Employer Information (Supervisor Contact info)
  • Claim Number & Date of Incident
  • Any Emergency Room documents pertaining to incident (If Applicable)
  • Any X-rays, MRI, Radiology, etc. Reports (If Applicable)