New Patient Forms

As principled family Chiropractors, we correct Subluxations, which is vertebra out of alignment. This misalignment blocks the life force from the brain to the body, creating dis-ease, thus a lowered state of health. By removing this interference, the body has the opportunity to be healed from the inside/out, and restore LIFE.

To save time at your first appointment, please fill out the forms below, print them and bring them with you to your appointment. No worries if you can't do so, we will provide them at the office if needed!

Save time at your first appointment

Blue Cross Blue Shield
Blue Care Network



Not all insurances provide the same benefits, if you would like to get a more accurate benefit summary please call our office at 313-565-4500 with your insurance information and we will give you a summary of your benefits. We cannot guarantee what your coverage will be. Some of the insurances listed above need a referral from your primary care physician before they will contribute to your benefits.

We also offer  cash wellness plans because don't want your insurance benefits to dictate your care. Our goal is to provide quality, caring and affordable chiropractic care for your entire family.

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit