Patient Forms
Patient Forms
Welcome! If you’re planning your first visit to Delp Chiropractic, we look forward to meeting you. To save time on your first visit, we encourage you to print and fill out our new patient forms below.
If you do not already have AdobeReader® installed on your computer, Click Here to download.
Download the necessary form(s), print it out and fill in the required information.
Complete your forms and bring them in with you to your appointment
New Patient Form
- FILL OUT ONLINE
Auto Accident Form
- FILL OUT ONLINE
Medicare Form
- FILL OUT ONLINE
Insurance Accepted & Self Pay
We accept most all major insurances. This includes Medicare and VA patients. We accept patients injured in automobile accidents and worker’s compensation injuries. We do not accept Medicaid insurance however we can see patients that have Medicaid and offer them payment options.
We accept patients that are self-pay, and we offer payment options to help make the care you need more affordable.
MEDPAY INFORMATION
Medpay is a benefit on your own personal auto insurance that will help to cover your medical bills when you are in an accident until settlement is made with the other insurance company.
You’re more than likely already paying for it on your insurance policy
After case is settled, Delp Chiropractic will write you a check for the remaining Medpay amount.
Easy Steps
1. Call your insurance and ask if you have medpay on your policy.
2. If you do, ask them how much coverage you have. (Most policies cover it)
3. Start a claim, get the name of your adjuster, a claim number, and a phone number where you can reach them.
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