ATLAS FAMILY CHIROPRACTIC
1255 Boyson Loop, Hiawatha, IA 52233 • Get Directions
PHONE: (319) 393-7744 • FAX: (319) 393-1035 • EMAIL: nelsonatlas@live.com
These forms may be filled out in advance and faxed to us, emailed to us, or brought with you to your first appointment. Please contact our office with any questions you may have.
IF YOU HAVE MEDICARE INSURANCE,
please also download the Medicare ABN Form in addition to the intake forms:
IF YOU ARE SEEKING TREATMENT DUE TO AN AUTO ACCIDENT OR WORK INJURY,
please also download the motor vehicle accident/worker's compensation form in addition to the intake forms:
Here you will find information on what a first-time appointment looks like, information on insurance, and intake forms you can download.
Any new experience, especially when it comes to your health, can be unnerving. We understand this and will make every effort to make your first experience very comfortable. Our friendly staff and Dr. Sellers will answer any questions or address any concerns you may have.
We recommend for your first appointment that you download the required forms below, print them, fill them out in advance, and bring them in on your first visit. If you are unable to do so, please arrive at least 15 minutes prior to your appointment to complete the necessary paperwork.
A complete health history is the first step for any new patient. We will ask about old injuries, chronic problems, and your current symptoms. During this first appointment, please tell Dr. Sellers about your sensitive or painful areas and when the pain started.
During this first appointment, Dr. Sellers may inquire about your family history, dietary habits, job or work habits, and any previous treatments for your current condition (chiropractic, osteopathic, medical, etc.) After reviewing the health history, Dr. Sellers will discuss her findings with you and determine how your condition could best be treated.
If Dr. Sellers feels that chiropractic can help you, then (and only then) will she recommend a treatment plan, or if conditions allow, discuss a variety of treatment options. Treatment will be tailored to your specific needs, addressing your specific health problems and personal concerns. Aside from chiropractic, other therapeutic methods, such as physical therapy, massage, or home care remedies may be recommended.
YOUR FIRST VISIT
FORMS
IF YOU HAVE WELLMARK (BLUE CROSS BLUE SHIELD) INSURANCE,
please also download the Wellmark Member Acknowledgement Form in addition to the intake forms:
IF YOU HAVE MEDICAID INSURANCE,
please also download the Medicaid ABN Form in addition to the intake forms:
INSURANCE
ALL NEW PATIENTS, please download the intake and policy forms:
Most insurance plans are accepted at our office. If you are unsure if we accept your insurance company, please contact us. However, just because we accept your insurance company does not automatically mean your services will be covered.
It is our office policy that all patients need to directly verify with their insurance that we are in-network with their specific plan, that chiropractic care is included in their insurance benefits, how many chiropractic visits they are allowed per year, and how much chiropractic care will cost them. We cannot provide patients this information. This ensures accurate information and no miscommunication.
We are aware that these services, when performed by a chiropractor,
are not covered by these insurance companies:
Medicare: Does not cover the initial exam, any re-exams, or any x-rays
Medicaid: Does not cover the initial exam or any re-exams
UnitedHealthCare and UMR: Does not cover any x-rays
TriCare: Does not cover ANY chiropractic services