Patient Forms
New patients at our Lakewood chiropractic clinic are asked to fill out a brief form. Click here to download, print off, and fill out our patient form.
Our form asks straightforward questions about your health and current issue. We want to know the reason – or reasons – you’re visiting our clinic. We also ask basic questions about your social history, your family history, and your chiropractic history – if any.
The goal of our patient form is simple: chiropractic is a holistic profession that treats your body as an integrated unit. By getting the full picture of your overall health, we’re able to address your issue in the most effective way possible.
What Can I Expect From My Chiropractor?
Going to the Chiropractor is a new experience for many of us. Maybe we’ve heard through a friend or have done some research online. It’s possible that you are just fed up with living in pain and it’s time to do something about it. In either case, your first visit to the chiropractor will really be about getting to know the chiropractor and discussing your history, current condition and goals.
As with any doctor’s visit, you’ll start by finishing some new patient paperwork. Upon meeting with the doctor, you’ll discuss your concerns and expectations as well as have the chance to ask any questions you may have. We will perform a physical examination and most likely take a few x-rays to see what your current state is. Once this is complete, we’ll take a look at the overall results of our conversation and the exams. Together, we’ll come up with a plan of action which will begin when you are completely satisfied and ready to move forward.
First visit history, exam, consultation
- History: In order to provide you with the best quality care and insure we have all the information about your case we will be doing a detailed history, exam, and consultation. Dr. Jumper will spend as much time as necessary with you to determine the cause of your problem. Dr. Jumper will explain to you how He practices and a few fundamentals to make sure you are comfortable and that everything fits within your belief system.
- Exam: The examination that will be performed will include specialized tests to determine which tissues are being affected and to what extent. Dr. Jumper will be doing a neurological evaluation, sEMG tests or Surface Electronic Myleograph studies. Much like how an EKG measures the condition of the heart muscle, this will measure the activity in your muscles at injured areas and gives Dr. Jumper a clearer picture of how encompassing your problems are. Other tests that will be performed include a neurological test, orthopedic testing, 3-Dimensional postural Exam, Gait analysis, muscle testing, as well as on site 20/20 Digital X-Rays.
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Consultation: Dr. Jumper will sit down with you and go over all the findings from your history and exam. He will explain to you what the treatment plan will be. If He cannot help you he will advise you if a problem would be appropriately managed by another health care provider. If Dr. Jumper does accept your case He will go over the following with you:
- Where the problems are.
- What is it going to take to fix it?
- How long will it take?
- How much it will cost?
- What is my out of pocket expense?
- How you will maintain it once your spine is fixed. Because if you don’t maintain it don’t fix it. That would be a waste of time and money.
We will then be going over different treatment options as well as a recommended course of care. Our goal with you will be to fix your spine in the shortest amount of time and in the most cost effective way.
Insurance accepted and payment plans
We accept most health insurance plans, but sometimes they don’t accept us. Call and speak with our billing specialist at to find out if your insurance company will contribute towards your health care needs in our facility. Individuals in need of our service who lack insurance and who are concerned about payment need not to worry. We have very affordable rates and flexible payment options allowing access to the highest-quality care available for you and your family. Many patients put off treatment because they cannot afford to pay.
Our office offers Care Credit payment options as an alternative to consumer credit cards, cash or checks. Care credit allows you to pay over time instead of a lump sum prior to treatment.
Insurance Billing
Before you do, please consider the following…
- If you file a claim with your insurance company, all diagnosis codes and test results will go on file with your insurance company. This can be used to determine future premium costs for you and your family.
- If your diagnosis includes a hereditary disease like high blood pressure, it will not only be seen on your health records, but also the records for your children and grandchildren and will be used to determine their coverage availability and premium costs.
- Insurance companies are quick to raise premiums or drop coverage entirely when customers file too many claims, or just one of the wrong kind of claim (like nutritional treatment rather than the medical drug-fix it norm).
- Your insurance carrier is responsible only for paying benefits covered under your policy and will deny anything they deem “medically unnecessary or experimental”. Nutritional services frequently fall under this category and therefore are not covered which means you are supplying them with diagnosis codes, test results, etc (which they can use against you) yet you see no financial benefit.
- Rescission – if you have a serious illness, insurance companies will search your file to obtain medical records from the last several years and if they find any inconsistency in your application, your policy is rescinded so they can avoid paying for costly treatments or medication. Any information you share with them could be used against you.
- Preapproval – if you call your insurance company to find out if certain services are covered, it is a warning sign to your provider that bills are coming which may spark a rescission search on your account.