Chiropractic Healthcare Center

Chiropractic Healthcare Center
15324 Main Street East, Suite B
Sumner, WA 98390

ph: (253) 863-5323
fax: (253) 863-2034

Forms

We are preferred providers for all major insurances.  Bring in your insurance card and we will check your benifits as our courtsey to you.  We will let you know exactly what will and will not be covered.

Make your initial visit go quicker by following the links below and completing the necessary paperwork.   

   

Registration

Informed Consent

Hipaa

 

Precertification Forms

   Optum and ACN Insurance Only

Patient Summary Form

Neck Index

Back Index

 

Automobile/Personal Injury Forms

Personal Injury Form Page 1

Personal Injury Form Page 2

 

 

 

 

 

 

 

 

 

 

 

 

WE ACCEPT

  • Medicare
  • Regence
  • Cigna
  • Aetna
  • Premera
  • HMA
  • United Healthcare
  • First Choice
  • Uniform Medical
  • Labor & Industries
  • Humana
  • Zenith
  • Great-West
  • ACN
  • Healthways                                                 

Copyright this business. All rights reserved.

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Chiropractic Healthcare Center
15324 Main Street East, Suite B
Sumner, WA 98390

ph: (253) 863-5323
fax: (253) 863-2034