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.
- Pain Chart
- Back Index
- Neck Index
- Lower Extremity Funcational Scale (LEFS) Index
- Quick (DASH) Disabilities of the Arm, Shouders and Hand Index
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)