Information for New Patients
Click on a link below and print the form(s) you need, fill out and bring them to the office on your first visit.
All forms are PDF files and require Adobe Reader to open and print. Need Adobe? Use this Adobe link and
click "continue:"
Click on a link below and print the form(s) you need, fill out and bring them to the office on your first visit.
All forms are PDF files and require Adobe Reader to open and print. Need Adobe? Use this Adobe link and
click "continue:"
New patients should plan on spending approximately one hour at our office on their first visit. The doctor
will perform a thorough examination and recommend treatment options. If time permits, treatment may be
initiated at the same visit.
Please be sure to bring along any reports, x-rays, MRIs or other information that may help the doctor arrive
at a diagnoses and formulate a successful treatment plan. We do not perform x-ray services at our offices.
The doctor will be happy to consult with other treating physicians you may have working with you. Be sure
to inform the receptionist when you arrive if you prefer inter-physician consultation.
If your insurance company requires a referral from your primary care or other treating physician, please be
sure to obtain the referral prior to arrival for your first visit.
If your condition is due to a personal injury matter or workmen's compensation case, please call our office
for additional forms that can be faxed or emailed to you, or that you can pick up at the office. Feel free to
have your employer representative, insurer or legal representative contact us if necessary.
We're looking forward to meeting you and helping you on the road to recovery!
will perform a thorough examination and recommend treatment options. If time permits, treatment may be
initiated at the same visit.
Please be sure to bring along any reports, x-rays, MRIs or other information that may help the doctor arrive
at a diagnoses and formulate a successful treatment plan. We do not perform x-ray services at our offices.
The doctor will be happy to consult with other treating physicians you may have working with you. Be sure
to inform the receptionist when you arrive if you prefer inter-physician consultation.
If your insurance company requires a referral from your primary care or other treating physician, please be
sure to obtain the referral prior to arrival for your first visit.
If your condition is due to a personal injury matter or workmen's compensation case, please call our office
for additional forms that can be faxed or emailed to you, or that you can pick up at the office. Feel free to
have your employer representative, insurer or legal representative contact us if necessary.
We're looking forward to meeting you and helping you on the road to recovery!
| ChiroCare Plus, P.C. * 3204A Ironbound Road * Williamsburg, VA 23188 Phone (757) 565-6464 * Fax (757) 565-7714 |
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Basic information about you.
Information regarding your insurance coverage.
Information for payment to the Doctor.
Information regarding keeping your personal health information confidential.
Authorization to release notes about your treatment to a person you specify.
Information about your current health status and past health history.
What You can Expect on Your First Visit
* Consultation. At your first visit, you will be asked to bring in the completed patient forms above, or to
complete them in the office. Your insurance benefits will be verified, and the physician's assistant will ask
some basic questions with regard to your health and the condition that brought you in to see us; she will
also check your blood pressure and current weight.
* Examination. The doctor will perform a thorough chiropractic examination, which may include testing of
orthopedic, neurological, postural and physical status, as well as testing your reflexes, range of motion and
sensory measurements. This will allow the doctor to arrive at an accurate diagnoses and formulate a
custom treatment plan tailored to treat your specific condition. The doctor will also review any x-rays or
other diagnostic tests or reports you may have brought with you.
* Your Treatment Plan. Your customized treatment plan will outline the number of visits the doctor would
like you to schedule each week, and the number of weeks it will cover. When you demonstrate significant
improvement, or if the condition is persistent and resists initial treatment, the doctor will adjust your
therapies and visit frequency accordingly. Aggravation or exacerbation of your condition may also alter
your treatment plan.
* Treatment. Physiotherapy, chiropractic manipulation, acupuncture or other therapies will be
recommended and implemented either at your first visit or the next. The doctor may give you home
instructions to follow until your next visit, as your treatment progresses, or to permanently assist with
preventing a subsequent occurrence of the same condition.
* Exercises. The doctor may prescribe and instruct you in specific exercises for you to perform at home that
will speed your recovery and avoid a recurrence of your condition.
* Orthopedic Support. The doctor may determine your condition may benefit from the use of an orthotic
support such as custom shoe inserts, joint supports, home traction unit, travel pillow, back rest or other
beneficial item, which will be dispensed at our office.
* Consultation. At your first visit, you will be asked to bring in the completed patient forms above, or to
complete them in the office. Your insurance benefits will be verified, and the physician's assistant will ask
some basic questions with regard to your health and the condition that brought you in to see us; she will
also check your blood pressure and current weight.
* Examination. The doctor will perform a thorough chiropractic examination, which may include testing of
orthopedic, neurological, postural and physical status, as well as testing your reflexes, range of motion and
sensory measurements. This will allow the doctor to arrive at an accurate diagnoses and formulate a
custom treatment plan tailored to treat your specific condition. The doctor will also review any x-rays or
other diagnostic tests or reports you may have brought with you.
* Your Treatment Plan. Your customized treatment plan will outline the number of visits the doctor would
like you to schedule each week, and the number of weeks it will cover. When you demonstrate significant
improvement, or if the condition is persistent and resists initial treatment, the doctor will adjust your
therapies and visit frequency accordingly. Aggravation or exacerbation of your condition may also alter
your treatment plan.
* Treatment. Physiotherapy, chiropractic manipulation, acupuncture or other therapies will be
recommended and implemented either at your first visit or the next. The doctor may give you home
instructions to follow until your next visit, as your treatment progresses, or to permanently assist with
preventing a subsequent occurrence of the same condition.
* Exercises. The doctor may prescribe and instruct you in specific exercises for you to perform at home that
will speed your recovery and avoid a recurrence of your condition.
* Orthopedic Support. The doctor may determine your condition may benefit from the use of an orthotic
support such as custom shoe inserts, joint supports, home traction unit, travel pillow, back rest or other
beneficial item, which will be dispensed at our office.
Your consent to receive care and treatment in our office.
Use if you want us to discuss your treatment with someone you designate.