Insurance Benefit Check Form

Many people have chiropractic coverage under their insurance. Before you come in for your first appointment, as a courtesy to you, we will gladly research your insurance coverage; however, ultimately, you will be responsible directly to The Bodhi Tree Clinic for full payment of your account if your insurance company does not extend coverage for our services. This form will need to be submitted at least 24 hours in advance of your treatment.

Name *
Birthday *
We may not be In Network with all companies listed below
Usually on the back of your insurance card