New Patient Information
Welcome! If you are a new patient, be sure to call our office to schedule your first visit. Submitting the new patient intake below will NOT result in a new patient appointment. Interested in who we are or what we do at our office? Click the highlighted links for more details! We hope to meet you soon!
New Patient Intake Form for New Patient only (do not submit from a mobile device, iPhone or iPad)
New Adult Patient Health Questionnaire
New Pediatric Patient Health Questionnaire
HIPAA / Financial Policy / EZ Pay Form
At Well Spine Family Chiropractic we strive to keep our fees as close to a normal co-pay as possible. If you are a self-pay patient or would like to use your Health Savings Account or Flex Spending Account for your services, our rates are as follows:
Current Fee Schedule (2018)
We are an in-network provider for Medicare and accept Medpay for Motor Vehicle Accidents. For the following policies, we are considered out-of-network providers: Aetna, Anthem/Blue Cross & Blue Shield, Cigna, Columbine Health Plans, Humana and United Health Care. We are happy to provide you with a Superbill, if you have out-of-network benefits, and would like to submit to your insurance for reimbursement.
We became out-of-network providers in early 2017 as many of our patient's co-pays and deductibles were continually increasing, often exceeding our self-pay fees.
If you have questions about whether your health insurance provides you with chiropractic care coverage, please call our office at 720-403-8255 and our staff will be happy to verify your insurance benefits for you.
Were you in an auto accident and have questions about Medical Pay!? Read more about Med Pay here! (Click on Link)
** We are no longer participants of the Moxie Mom partnership. We continue to be partners with Mod Moms and offer a 10% discount to those who are members. Discount applies to new patient exam for an adult and/or pediatric patient.**