Before you can be seen for your initial visit with Dr. Ambrose, you will need to fill out many of the forms listed below. We do ask that you try to print off and fill out the forms prior to your visit, for a speedier transition.

All of the forms listed below are in Adobe PDF format. You will need the free Adobe Reader to view and print the forms. If you do not have the Adobe Reader software program, It's FREE. Just click the "Get Adobe Reader" button at the bottom center of this page.

IMPORTANT! If you're coming to see us as a result of and auto-related accident you must, in addition to these forms, fill out all forms in the Personal Injury Forms section. This means you will have eight forms to download and SEVEN that must be filled out before coming in.

• Case History Form 122kb download
• Completely Natural Chiropractic HIPAA privacy form 74kb download
• HIPAA privacy patient signature form 63kb download
• New patient insurance handout 107kb download
• Authorization to bill health insurance 70kb download
• Doctor's Lien Form 70kb download

We cannot stress this enough...PATIENTS ARE STRONGLY ENCOURAGED TO CALL THEIR INSURANCE COMPANY FOR THEIR BENEFITS! If our office calls on your benefits as a courtesy, this is in NO WAY a guarantee that your insurance will pay for services. Ultimately patients are always fully responsible for cost of care incurred.

Many patients wish to know about their insurance benefits but don't really know how to check and which questions to ask. These two forms can be printed off and will give you the tools to get your specific chiropractic benefits from your insurance company. Please follow the instruction sheet and fill out all information on your form. If done, please bring in your completed form to our office on your first visit.

VERY IMPORTANT! If you need a referral, either from your insurance or physician, it is your responsibility to obtain such before coming in for your initial visit. If your insurance does NOT pay for care because of a lack of referral, you will be responsible for payment. Our fax number is (804) 750-1865.

• Insurance Instruction Sheet 115kb download
• Benefits Form Sheet 124kb download

This applies to persons who have been in an auto accident. Note, you must also fill out the above six forms as well.