Natural Life Chiropractic
131 E. Speedway Blvd.
 Tucson, AZ
 85705-7759
Ph: (520)-740-1718
Email Us

Natural Life Chiropractic Patient Information Form

For your convenience we have created three versions of
our Patient Information form for you to choose from:

Click Here for a Printable Online Version
 (works with all computers)

Click Here for the Microsoft Word Version
 (Compatible with All versions of MS Word)

Click Here for an Acrobat PDF Version
 (works with all computers with acrobat reader installed)
Download Acrobat Reader here

Regarding Insurance

Please call our office with your insurance information.  We will call your insurance to verify your benefits prior to your first appointment.  We will call you to let you know what they tell us your responsibility will be. 

 Insurance companies always state that the information given is not a guarantee of benefits.  It rarely happens, but if there are any discrepancies you will be held responsible for your charges.

Auto Accident Patients:  We need for you to bring in all pertinent paperwork.  Different types of accidents require different paperwork.  Usually we need:

1. Your auto insurance (policy number, claim number, the agent’s name and phone number).
2. The other person’s auto insurance (policy number, claim number, the agent’s name and phone number) if the accident was someone else’s fault. 
3. The police report.
4. A list of any other practioners or treatments you have received related to the accident.  Example:  ambulance, ER visit, primary care physician, etc.
5. Your lawyer’s name and phone number if you have retained one.
6. An up-front $30 lien processing charge for all auto accident patients.

Please call the office for more detailed information