new to the office? fill out this form

Insurance Carrier:

Name: *

As of MAY 1, 2023 we will no longer accept CIGNA health insurance. We accept BCBS, UHC, Aetna, Ambetter and Humana.

I N S U R A N C E A N D P A Y M E N T S :

Your health insurance contract is between you and your insurance company. Knowing your insurance benefits is your responsibility. Any questions or complaints regarding your coverage should be directed to your insurance carrier.

We are contracted with most insurance plans. If you are not insured by a plan we are contracted with, payment in full is expected at the time of service. Co-payments, coinsurance, and deductibles are due at the time of service. Payments can be made by VISA, MasterCard, Discover, American Express, or cash.

Please be aware that some or all of the services you receive may be non-covered or not considered necessary by your insurer. Payment for services of this nature will be required at the time of service.

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Preferred Date and Time: *

Insurance Carrier's Phone Number:

Email: *

Check here to receive email updates

Phone: *

Additional Information:

Member ID Number:

Type of Appointment: *

Chiropractic

Acupuncture

Adjustment ONLY

NOT a new patient, but need to provide 2023 insurance

Already an established patient? Request An appointment here

TEXT US AT 832-498-2236

721 east 14th, hOUSTON, tX 77008

This clinic transmits personal health information via electronic means, such as email.

Name: *

BY APPOINTMENT ONLY.

M-W 10am-6pm

Thur 10am - 2pm (Dr. Emily)

Fri 10am-2pm

This is to ensure the best one-on-one specialized care.

Most patient visits are 1 hour with complete interaction with the doctor.

Feel free to text, email, or submit the form online

to schedule a visit!

new to the office? fill out this form

Already an established patient? Request An appointment here

TEXT US AT 832-498-2236

​721 east 14th, hOUSTON, tX 77008

721 east 14th, hOUSTON, tX 77008