Forms and Insurance

New Patient Forms

All patients:

Please fill out our paperwork in this secure portal. Please click on the button below labeled: "Complete Paperwork Here"

Referring Providers for Hyperbaric Oxygen:

If you are a provider referring a patient for hyperbaric oxygen, please use this form:

HBOT 100% Oxygen Referral

UHC/Optum:

Some UHC/Optum patients need to fill out an additional form for chiropractic care, if you are advised to fill out this form by our team, please click the link below:

UHC/Optum paperwork

HIPAA Form

Please review this HIPAA document prior to your first appointment. You'll have the chance to sign off and ask questions when you arrive.

Insurance Options

Capital Chiropractic & Rehabilitation Center accepts most major insurance plans and also offers a self-pay option to best accommodate patients' access to whole-person wellness care.

To help you make the best choice about whether to use your insurance coverage or choose self-pay for your care here, please use the contact details below to contact your provider.

Ask them to verify how much coverage you have for chiropractic care, physical therapy, acupuncture/dry needling, soft tissue therapies, and nutritional counseling. Then record those details on our Insurance Verification Worksheet for your reference.

Please share a copy of your findings with us to minimize surprises for all of us as you seek care here.

Questions? We'd love to help. Please complete the Insurance Verification Worksheet and bring it with you to your appointment!

Insurance Verification Worksheet

Auto Accident Patients

To verify your insurance coverage for treatment, please use our Auto Insurance Verification Worksheet linked below.

Auto Insurance Verification Worksheet

Major Insurance Companies' Contact Information

Amerigroup

Health Partners

Medica

UnitedHealthcare

  • Website
  • Phone: Call the number on your Health Plan ID Card for the most direct service help.

Wellmark 

Self-Pay Option

We use The Wellness Group to offer a self-pay option that simplifies and streamlines patient access to care. Patients who choose this option typically are uninsured, underinsured, or prefer the reliable, simple rates and full access to all of our clinic's treatments. To learn more about this option, just ask at the front desk.

Are you a new patient?

New Patient Schedule Online
You can also book your first appointment by phone or email. If you have questions about your insurance or specific providers, calling or emailing may be your most efficient way to schedule a new patient appointment. We look forward to meeting you!