Monday - Friday: 7:30am - 6:00pm

(We will be closed for staff meetings on Tuesdays from
12:00pm - 2:00pm and Thursdays from 11:00am - 1:00pm)

(218) 444-2117 • 4228 Power Dr. NW, Bemidji, MN

Insurance & Forms

Use the following link to print/fill out your general health information:

General Patient Information Form

Please use the following links to print and fill out your insurance coverage and health history forms. The forms are in PDF format, and in order to view them, you need a PDF viewer such as Adobe Reader. If you do not have Adobe Reader, click here to download.

  • Individual or Group Insurance

    We take most of the hassle out of dealing with the insurance companies so you can focus on what’s most important, your health. Our staff would be more than happy to contact your insurance company to confirm the type of coverage they offer. Keep in mind, the benefits that are quoted to us are not a guarantee of payment by your insurance provider. As a result of this, we will go ahead and file your claim and wait 90 days for payment. In the event that your provider pays what they’ve quoted, you will only be held responsible for and deductibles or co-pays, as well as any non-covered services. If you have any questions regarding insurance or payments, feel free to contact our billing department and they will happily answer any questions you may have.

  • Patients Without Insurance

    We realize that there is a rising number of patients without insurance plans or limited coverage plans. We also realize that no one wants to take on a large payment. As a result, we have implemented multiple plans so our patients can receive their necessary treatment plan without the financial stress. We accept cash, MasterCard, Visa, Discover cards, and personal checks.

  • "On The Job" Injury (Worker's Compensation)

    Your employer should have Worker’s Compensation insurance that covers any employee that is injured on the job. In the event you are injured at work, you must inform your employer of your injuries and collect their Worker’s Compensation insurance information. If we do not receive your employer’s information or make a settlement within three months, all services and fees will be due. This also takes effect if you dismiss or suspend your care.

  • Personal Injury or Automobile Accidents

    After an auto accident or personal injury, you will need to inform your insurance company immediately of your visit to our office. Also, it is very important that you notify our billing department about any attorney that may be representing you. With these type of injuries, you are held accountable for your bill, however, we will wait for any settlement for up to six months after your treatment plan is finalized. As soon as you suspend or dismiss your treatment, or your claim is settled, and service or fees will be due.

  • Medicare

    We accept Medicare; however, Medicare typically will send a check straight to our office for the services they cover. Medicare will only cover eighty percent of the total charge and ONLY covers manual manipulation of the spine. The patient will be accountable for the deductible and the remaining twenty percent along with any services not covered under their Medicare benefits. Our billing department will complete and file all the forms at no charge.

  • Secondary Insurance

    In the event you have any type of secondary insurance, please inform us upon your first visit. We will be happy to assist you.

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