New Patient Information

New Patient Paperwork

Palm Harbor Chiropractic & Wellness Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Fax us your printed and completed form(s) or bring them with you to your appointment.

Insurance

We accept most insurance plans, and our staff will be glad to review your benefits with you before your visit, free of charge. Of course, we welcome patients who don’t have insurance, and do our best to keep our fees as reasonable as possible so that no one is limited in the care they receive. If you have questions about your insurance, feel free to give us a call.


Payment Policy

Our Policy: Any person responsible for payment has the right to refuse pay, cancel payment, or be reimbursed for payment for any service, examination or treatment which is performed as a result of and within 72 hours of responding to an advertisement for the free, discounted fee or reduced fee service, examination or treatment.

Please Note: Not applicable to Medicare due to Federal Law

accepted payment method

Monday
9:00am - 6:00pm


Tuesday
9:00am - 6:00pm


Wednesday
9:00am - 6:00pm


Thursday
9:00am - 6:00pm


Friday
9:00am - 1:00pm


Saturday
CLOSED

Palm Harbor Chiropractic & Wellness Center
550 US-19 ALT
Palm Harbor, FL 34683
(727) 789-0800