PATIENT FORMS

Authorization to Treat Minors

SELECT ONE

Cash Patients
Insurance Patients
Personal Injury Patients

  • We support these plans & payment options:

    • PPO’s Only, No HMO’s

    • Blue Shield

    • BRMS

    • Chiropractic Health Plan of California

    • First Health / CCN

    • International Longshore & Warehouse Union – ILWU

    • Cash or Check

    • Zelle

  • We understand there are times when you must miss an appointment due to emergencies or obligations for work or family. Please call/text to cancel an appointment at least 24 hours prior to your appointment.  There is a charge of $100 for not showing up for scheduled appointments OR for a LATE Cancellation. 

    Note: this fee will not be covered by your insurance company.  

    • If you do happen to cancel late, but we are able to fill the slot, you will not be charged.

    • The first offense will be considered a “warning.”

    • Repeated cancellations or missed appointments will result in loss of future appointment privileges and/or potential dismissal from the practice.