For your convenience you can complete your new patient intake form online here.
At Heart of Florida Chiropractic we are looking forward to serving you as a new patient! For your convenience we have our New Patient Intake Forms available online. Filling out our forms electronically will help expedite the process on your first visit.
Here at Heart of Florida Chiropractic we utilize Electronic Health Records software. The secure link will allow you to complete your information in the comfort and privacy of your own home so that we can upload it into our system when you arrive in our office. If you are unable to complete the form online we will be happy to provide you with a paper or electronic copy to complete in the office.
What to expect on your first visit
In response to the COVID-19 pandemic we ask that if you develop a cough, fever, shortness of breath, or any other symptom of COVID-19 or have been in close contact with someone who has been diagnosed or us suspected of having COVID-19 we ask that you contact the office so we can reschedule you accordingly.
Upon arrival at our office you will be greeted at the front desk. If you have already completed the intake paperwork online we will ensure all of your forms have been imported. If you were unable to complete your paperwork online you will be provided with that in office.
We will take a copy of your license and insurance card if you would like us to submit claims to your insurance company. The Doctor of Chiropractic will then review your paperwork with you and take a detailed history before performing a physical examination. Based on your history and examination findings the Doctor of Chiropractic may decide X-Rays are warranted before proceeding with care. The Doctor will review their findings and discuss their recommendations with you before proceeding with any therapies or chiropractic adjustments. Finally you will return to the front desk where you can check out and schedule future appointments.
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
• You have the right to receive a Good Faith Estimate for the total expected cost of any nonemergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
Schedule your New Patient Appointment Below:
Please be advised that when scheduling a new patient appointment online you will be directed to a payment page and must enter a valid credit card to hold your appointment. This card information will be collected as an “authorization only” and the card will not be charged at scheduling. You will receive an email with new patient paperwork to complete after scheduling and a reminder text/email 24 hours in advance of your scheduled appointment Please respond to the reminder with your confirmation. If you do not cancel or reschedule your appointment with at least 24 hours notice, we will assess a $50 “no show” charge to your account. This “no show” charge is not reimbursable by your insurance company and your authorized credit card on file will be billed directly for it. This “No Show” Policy allows us to optimize schedule availability and best serve our patients. We look forward to meeting you!