discount New Patients:

To ensure our patient schedule is running as efficiently as possible, we ask you to arrive 10-15 minutes early to complete the necessary paperwork.  Our forms are located on this website and can be printed off and completed before you arrive.

These forms include:

  • New Patient Information - includes patient information, insurance, phone numbers, accident information, patient condition, health history, and medications/vitamins.
  • HIPAA Notice of Privacy Practices - describes how your protected health information may be used and disclosed by Dr. Smith, our office staff, and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of Dr. Smith’s practice, and any other use required by law.
  • Financial Policy - states that we will submit all your claims to any insurance you may have and will file the necessary paperwork, but ultimately you are responsible for your account balance remaining with Rock County Chiropractic.
  • Terms of Acceptance - explains what an adjustment is and the risks associated with any medical treatment, including chiropractic.  By signing the Terms of Acceptance, you give Dr. Smith permission to treat you. 

waitingroom Other forms may include a Low Back or Neck Questionnaire, Work Comp, Pediatric Intake Form, or Vehicle Accident Information form, depending on your area of complaint.

Dr. Smith spends approximately 30 minutes during the first visit in which he will complete a detailed health history and examination of your condition.  Chiropractic care may not be appropriate at this time, and if this is the case, Dr. Smith will refer you to the proper health care professional.  If Chiropractic care is appropriate, you will receive a treatment during this initial visit.  A referral for x-rays will be made if Dr. Smith determines them to be medically necessary. 

Dr. Smith will take the time to explain your condition along with his recommendations for treatment.  Homecare recommendations such as stretching and strengthening exercises will be provided to aid with recovery and prevent recurrence.  Goals based on both Dr. Smith’s recommendations and your needs will also be set at this time.  Dr. Smith is open to any questions or concerns you may have throughout the course of your chiropractic visit, so please feel free to discuss your health concerns at any time as patient education and understanding is very important to recovery! 

If you would like a copy of our HIPAA Notice of Privacy Practices select the link and print: HIPAA Notice of Privacy Practices