492 E 13th Avenue, Suite 200 Eugene, OR 97401 (541) 342-4520

Chiropractic  Healing Center

New Patient Information

New Patient Information

Tharon and Jill

Our Support Staff: Tharon & Jill

Please come 15 minutes earlier than scheduled time for your first visit to fill out intake forms. You can also download and print the forms below to complete in advance.

We require payment
(either copay, co-insurance or in full) at the time of service for all patients, except those covered by Auto and Workers Compensation insurance. We will bill your insurance* for each visit.

Please be familiar with your insurance policy before coming to your first visit. We need to know:

    • What is your co-pay for each visit?
    • Do you have a yearly deductible that must be met?
    • Do they pay for out-of-network providers?

Dr. Adams is currently contracted with PacificSource only.
Dr. Aptecker is contracted with PSP and Blue Cross/Blue Shield.

If your reason for joining us at CHC is related to a car accident or a work injury please inform us when calling to set up your first visit. We will bill insurance*.
We need to know:

  • The name and billing address of the insurance company covering your treatment. (In the case of a car accident, that is the insurance for the car you were in, not necessarily the car at fault)

For your comfort and ease of treatment please wear comfortable and soft/pliable clothing.

Forms:

The forms below can be downloaded and filled out prior to your visit:

Registration Chiropractic
Registration Auto Accident
Registration Massage
HIPAA Information