Achieve Health Chiropractic Clinic
Wellness care for the entire family!
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ACHIEVE HEALTH CHIROPRACTIC CLINIC 13911 RIDGEDALE DRIVE, SUITE 200 MINNETONKA, MN 55305
(o) 952.545.3839 (f) 952.546.0168 firstname.lastname@example.org
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schedule your chiropractic,
massage or acupuncture appointment.
Please print these forms and fill out completely before your first visit.
Feel free to call the office at 952.545.3839, if you have any questions or concerns.
If you are unable to print these forms, please come in 20 minutes ahead of your
scheduled appointment or call us to fax, email or mail you the forms.
Please have forms completely filled out and bring them to your first visit.
This will allow you to have the full time with the doctor.
Please call your insurance company to find out your chiropractic benefits before your first visit.
Please use our "Patient Insurance Verification Form” to find out your benefits.
PATIENTS WITHOUT INSURANCE:
We offer affordable cash plans. Ask for more information when you visit us.
We accept cash, check, Visa, Mastercard and Discover.
MEDICA, PREFERRED ONE, MEDICARE,
AUTO*, PERSONAL INJURY*, WORKER’S COMPENSATION*
*Please have your claim number available when you come to our clinic.