PSC new patient intake FORM

PSC supports your health care needs, provides affordable care and several options for you to cover the cost of your medical and health care services.

• Accepted forms of payment for Services provided by PSC include  Remittance by your Health Insurance Carrier for claims filed, HSA,  FSA, Credit Card, Cash, Debit Card, and Check.

• Payment is due at time of  your appointment upon the rendering of medical and healthcare services.

• Co-pays, Deductibles,  and/or Full Payments are Expected at time of Appointment unless unique, special, or unexpected circumstances arise.  

• Most Healthcare Insurance Accepted; Benefits will be Verified and Available at time of Appointment for Chiropractic Care and Physical Therapy; Claims will be filed on your behalf if deemed appropriate. Massage Therapy is a separate arm at Premier Spine Center (PSC) and is Self-Pay only.

• Self-Pay options are available for Chiropractic Care and Physical Therapy patients without Healthcare Insurance or with high deductible Insurance Plans.

• General and Specific Information regarding Personal Injury Cases will be Provided based on Individual Plans, PIP, and/or  by third party coverage; Attorneys involved will be notified immediately.

• Fees for established patients and clients will be applied for No-Shows or No Call within 24hrs of your Scheduled Appointment; Time is Valuable to Us, You, and All of Our Patients and Clients.

*If you have questions/inquiries, please ask! Making sure you are clear and comfortable while receiving care at Premier Spine Center (PSC) is a top priority. We Value You and Appreciate You Coming to Our Practice for your Healthcare needs! Call for an appointment today at 301.326.2235.