New Patients Welcome!
- Welcome New Patients
- New Patient Forms
- Insurance & Payment Info
- Your Patient Portal
- Transfer Your Records
Appointments & Arrival Time
All new patients should arrive 30 minutes prior to their first appointment to complete necessary paperwork. If you desire, much of this paperwork can be completed in advance. You can find these forms in the TAB labeled New Patient Forms (on this same page, one tab over). You simply click on the set labeled New Patient Packet and then print the forms.
(All of the pages are required, so please complete the full packet and bring all pages to your first appointment. Patients who fail to bring them or fail to complete them in the office prior to their appointment time may have to be rescheduled to another date or time.)
What to bring for your first appointment:
- All New Patient Packet forms completed in advance OR arrive 30 minutes prior to appointment time.
- Insurance card
- Photo ID
- List of current medication (can be written on the above form OR a copy of an existing list supplied.)
- List of questions or concerns
Late Arrivals and Cancellations
Please arrive on time for all appointments. If you arrive more than 5 minutes late, your appointment may need to be rescheduled. If you are running late, please call to see if we can slip you in at a later time; we will do our best to help!
As a courtesy to other patients, please provide 24-hour notice for cancelled appointments. Patients who do not show up and do not cancel may be charged for the missed appointment.
- New Patient Packet (all forms are required to be completed, signed, and returned to clinic at first visit) (pdf)
Occasionally, details revealed during your your initial visit or during your treatment plan may indicate the need for additional information. Below are some forms that our staff may commonly request. You do not need to complete the forms below for your first visit. We will direct you to these forms if they are needed.
- Symptom Survey (for nutritional evaluations) (pdf)
- Accidental Injury Report Form (pdf)
Health Back Center staff and providers recognize that you may have family, friends or other people involved in your health care. Please review and complete this form if you intend to have others communicate with our providers and staff. Please review the form for additional information and approved alternative methods of contact.
- Verbal Communication/Voice Mail Messages (pdf) (This form is already included in the new patient packet; this individual copy is made available for patients who desire to make changes to the privacy directives they have previously submitted.)
- Yearly HIPPA Privacy Policies and Forms (to be completed at the beginning of each new year or at least once per calendar year, as well as any time you desire to change your privacy directives; may also be completed in the Patient Portal.)
Insurance and Payment for Services Rendered
Health Back Center participates with a large selection of insurance providers, including Blue Cross Blue Shield and Medicare. If you have questions about your benefits, coverage, or network participating providers for your carrier, please check with your insurance carrier directly.
All new patients should come prepared to pay for the initial date of service in full. If you have questions regarding services and fees, our staff would be pleased to discuss these with you prior to your receipt of any billable services.
Once your insurance eligibility is confirmed, this clinic may elect to collect only your co-pay or co-insurance amount and file the remaining amount due to your insurance company. It is important for you to know that as a patient, you always remain responsible for full payment of the services rendered until they have been paid in full either by the insurance or by the patient. As a courtesy to our patients, we do file insurance claims electronically to many participating companies to minimize your paperwork. We can also provide you with an itemized statement for your MSA or HSA upon request.
It is also our pleasure to serve non-insured or private-pay patients, as well as patients involved in an automobile or personal injury accident. (We do not accept patients involved in Workers Compensation cases.) Payment for these accounts is expected at the time services are rendered. For your convenience, we accept cash, check, MasterCard, Visa, American Express and Discover Card.
Transferring medical records
During your Initial Exam with Dr. Pearson, Doctor will determine which, if any, previous records are applicable to current treatment and may be needed. If a transfer of records is necessary, we can assist you in completing a release form giving the former Provider permission to transfer your records to your Health Back Center.