If you experience any difficulties, (or if you are not using a forms-capable
browser) you may email your response to this form to: DrTom@Vitalityweb.com.
You can also call MARIA in our front office to check your insurance at (619)
296-2225. Be sure to tell her you found us on the Internet!!
Few people realize that most insurance policies cover chiropractic
care. If fact, Blue Cross/Blue Shield, Aetna, as well as Medicare,
have covered chiropractic care for years. These carriers have come to
recognize that chiropractic care effectively treats many
In addition, many HMO's and PPO's offer chiropractic care to their
subscribers. In fact, recent articles published in the Journal for
Managed Care cited chiropractic care as being more cost effective
than conventional medical therapies in treating low back pain. It is
a good chance that your local HMO could also cover chiropractic care.
Injuries resulting from auto accidents and work injuries are
covered 100% by your auto insurance and workers compensation policies
respectively. Many in-home injuries may be covered by home owners
Our insurance department will be happy to review your insurance
plan as well as fill out any of the paperwork required by your
insurance carrier. If you would like us to research your insurance
coverage prior to becoming a patient in our office, we need the
following information from your insurance card. Please complete the
following WebForm and Submit it to us using the "Submit Form" button
at the end of this page. If a field in this form does not apply to
you, then you may leave it blank.
Insurance Co: Insurance Phone:
Patient Name First: MI: Last:
Insured's Name First: MI: Last:
Insured's Soc Num: Employer:
Group Number: Plan Number:
Date of Injury: Policy or Claim Number:
Claims Adjuster Name:
Who should we contact with the results of our inquiry?
First Name: MI: Last Name:
Street: City: State:
Zip: Home Phone: Work Phone:
Fax: Cellular Phone:
All information will be deemed confidential. If you have any
further questions, or if you need us to put a rush on getting you
this information, Please call our office at; (619) 296-BACK(2225)