New Patient Forms

Cancellation Policy: When you call and schedule an appointment, time is reserved especially for you.  There is a deposit for new patients, which will be refunded only if the appointment is cancelled with more than 2 business days notice. For existing patients please allow a 48 Hour advance notice if you can not make your set appointment or a cancellation fee of $50.00 will be charged to your account.  

Payment/Fees:

For Dr. Jeremy Schiermeyer & Dr. Candice Mathis: The patient is responsible for paying for the visit at the time of  your appointment. Upon checkout, you will receive a “Super Bill” receipt. This “Super Bill” will have all necessary service, diagnostic, and doctor codes your insurance company will need. Please contact your insurance on where to send your “Super Bill”, your insurance can then process and reimburse YOU (the patient) for the percentage that it covers for Chiropractic Care. 

Medicare All Doctors: You are responsible for paying for your visit at the time of your appointment. Our office will submit claims to Medicare, and Medicare will reimburse YOU (the patient) for the percentage that Medicare covers for Chiropractic Care.