Luck has nothing to do with it. Complementary & Alternative Medicine Guide

Size: px
Start display at page:

Download "Luck has nothing to do with it. Complementary & Alternative Medicine Guide"

Transcription

1 Luck has nothing to do with it. Complementary & Alternative Medicine Guide 5584 MS Oxford Health Plans, Inc.

2 You say tomato. I say tomato. Oxford recognizes the obvious fact that people are different. And what s right for one Member may not be the best option for another. Realizing there will never be a single path to wellness, we always provide our Members with plenty of choices. In 1997, we were one of the first major health plans to offer a Complementary & Alternative Medicine (CAM) Program. No matter which path you choose to achieve wellness, Oxford provides you access to quality care through a network of credentialed providers. Today, Oxford Members have access to a vast network of board-certified doctors as well as a credentialed network of over 2,400 complementary and alternative medicine providers in Connecticut, New Jersey and New York. That means all of our participating providers meet state license and malpractice requirements, as well as clinical experience requirements. Each provider must also be recredentialed once every three years and must be committed to continuing education in his or her discipline. Because we believe that alternative care should complement traditional care rather than replace it, we encourage close communication between CAM providers, Members, primary care physicians (PCPs) and any other specialist who may be involved in providing care. For instance, when a Member shares the details of his or her CAM treatments and medicine use with a PCP, the PCP can look for potential interactions with conventional medicine, monitor progress, and possibly integrate the CAM treatments into the Member s medical treatment plan. Please read further to learn about all of Oxford s Complementary & Alternative Medicine Program benefits and how they may be helpful to you. complementary & alternative medicine Oxford Health Plans

3 All Oxford Members have access to the CAM Program Contracted Rate: You can visit any of Oxford s CAM providers without a PCP referral, at a specially negotiated rate. Simply select a participating provider, schedule an appointment, and pay the provider at the time of the visit. This is not an insured benefit, so there is no need for a PCP referral, PCP reimbursement, or paperwork. In most cases, this rate reflects a discount from the provider s normal fee. Standard In-Network Benefits: For medically necessary care, if your plan includes standard benefits for chiropractic and naturopathic (Connecticut only) coverage, you are required to obtain a referral for the initial visit. Precertification is required for any visits after the initial visit.* You will be responsible for a copayment at the time of the visit. Members of non-gated plans are not required to obtain referrals to participating chiropractors or naturopaths (Connecticut only). Alternative Medicine Rider: If your employer has purchased the alternative medicine rider, you can make medically necessary initial visits (subject to a copayment) to participating chiropractors, acupuncturists, and naturopaths (available to groups underwritten in Connecticut only) without a PCP referral. Precertification is required for any visits after the initial visit. The rider replaces any applicable standard in-network chiropractic or naturopathic benefit. Rider availability differs by region, employer, company size, and plan design. *If you have out-of-network coverage and access chiropractic care through a non-participating provider, the services will be reviewed for medical necessity. Members and providers can either: 1) Request prior approval through TRIAD by submitting the Voluntary Prior Approval Agreement Form along with an Initial Care Plan Form; or CAM features you ll find at Our web site is designed to give you convenience and options. Interact with us wherever you want, whenever you want, 24 hours a day, seven days a week (excluding periodic downtimes for maintenance). You can search for a CAM provider, change your primary care physician, check the status of a claim, and learn how to access the CAM Program. All you have to do is log in to and access the oxfordhealth Center from your personalized account page. You ll receive an abundance of information about our Complementary & Alternative Medicine Program. Some of the newest features within the CAM section include the following: ConsumerLab.com Oxford has recently contracted with ConsumerLab.com, a site that offers independent information and test data on vitamins, herbs and minerals, supplements, and natural products. In addition to test results, Members can get information on recalls and warnings, new product reviews, and drug interactions, gain access to the Natural Pharmacist Encyclopedia, and sign up for a free newsletter. CAM Connection The CAM Connection is where traditional medicine meets complementary medicine. Our site provides a link to dialogue from a roundtable forum on medical topics of interest. In this forum, conventional and CAM doctors share their perspectives on the patient s role in managing health and exploring avenues for care. For example, if the medical topic was cardiac wellness, panelists may talk about how achieving and maintaining cardiovascular health starts with prevention. Panelists may also try to get Members to understand how lifestyle awareness, proper nutrition, and health education contribute to cardiac wellness. 2) Submit clinical notes for medical necessity review to TRIAD after services are rendered and claims are submitted.

4 Choosing a Complementary & Alternative Medicine Provider Ways to find a CAM provider: Review your Oxford Roster of Participating Physicians and Providers Access the online Doctor Search tool at Call Customer Service at the number on your Oxford ID card, or at For more information about Oxford s Complementary & Alternative Medicine Program, visit Oxford s web site at or call Customer Service at the number on your Oxford ID card or at For a hearing impaired interpreter, you may call Oxford s TTY/TDD line at It s nice to have choices. Especially when it comes to your health plan. Acupuncture. Massage Therapy. Yoga. When you hear these words, do you think about your health plan? Probably not. But you should. Oxford Health Plans Complementary & Alternative Medicine (CAM) Program offers you discounted rates from a comprehensive network of providers, which includes acupuncturists, yoga instructors, massage therapists, chiropractors, nutritionists and naturopaths (Connecticut only). ACUPUNCTURE Acupuncture is based on the theory that life energy, called Qi (pronounced chee ), flows through the body. Any interruption of this energy flow could cause problems such as back pain, insomnia, or even migraines. Acupuncturists help restore the proper flow of Qi by inserting thin needles into specific points on the body, thereby releasing natural healing energies. Acupuncture may help with: Allergies Asthma Joint pain Colds and flu Depression Dental and facial pain Infertility Gynecological disorders PMS Stress

5 YOGA Yoga may help with: CHIROPRACTIC Chiropractic may help with: Yoga practitioners have been bending themselves into pretzel-like positions for more than 5,000 years. The word yoga means to yoke together, joining body and mind through exercise, breathing, and meditation. Yoga has been proven to help reduce stress, lower blood pressure, and even help insomnia. Addictions Chronic obstructive pulmonary conditions Sciatica Constipation Gastrointestinal problems Depression Migraines Heart disorders Menstrual disorders Obesity The chiropractic approach to healthcare emphasizes your overall health. Chiropractic practitioners analyze and locate the source of nerve interference associated with the body s muscular, nervous, and skeletal systems, especially the spine. They believe interference with these systems impairs normal functions and lowers resistance to disease. Through often-simple adjustments to the spine and joints, chiropractors help the body s natural healing powers alleviate pain and promote improved overall health. Low back pain Headaches Fatigue Stiff neck Asthma Irritable bowel syndrome Childhood ear infections NUTRITION Nutrition may help with: MASSAGE THERAPY Massage Therapy may help with: It s been proven that individual nutrients aid in the prevention and treatment of many diseases. For example, getting enough of certain vitamins, minerals and naturally occurring health-protective compounds called phytonutrients has been shown to protect against the development of heart disease, cancer, and other ailments. Nutritionists help prevent illnesses by promoting healthy eating habits, scientifically evaluating patients diets, and recommending diet modifications. Cholesterol Energy levels Sleep Stamina Skin Hair Digestion Acne PMS Prostate trouble Whether you re seeking relief for a medical condition, dealing with stress, or simply trying to maintain good health, therapeutic massage may be your answer. Besides just feeling really good, it can also lower blood pressure, improve range of motion, and increase endorphins, the body s natural painkillers. Stress Muscle tension and stiffness Discomfort during pregnancy Joint flexibility and range of motion Deeper and easier breathing Circulation of blood Movement of lymph fluids Tension-related headaches Musculoskeletal problems

6 NATUROPATHY (covered in Connecticut only) Naturopathic medicine is a distinctively natural approach to health and healing that is applied to the whole person, rather than just the specific problem. Naturopaths seek to heal the body from a holistic point of view. The body heals cuts, mends breaks, and controls infections naturally. When these self-repair systems become overwhelmed, they may require assistance. Naturopathic medicine aids the body s natural self-healing mechanisms. For example, to treat high blood pressure, instead of taking medication, a naturopath may suggest diet modification and breathing exercises. Naturopathy may help with: Colds Bronchitis Allergies Heart disease Diabetes Gastrointestinal problems complementary & alternative medicine Oxford Health Plans

Acupuncture PATIENT INFORMATION SHEET

Acupuncture PATIENT INFORMATION SHEET Acupuncture PATIENT INFORMATION SHEET What is acupuncture? Acupuncture is one component of traditional Chinese medicine that has been used for over 2,000 years to treat many health conditions. It is a

More information

The Wellness Lounge Staff

The Wellness Lounge Staff Chiropractic Massage Acupuncture Nutrition Yoga Treatment Welcome, We would like to take a moment to welcome you to the wellness lounge. Whether you are here for a one-time visit, or are looking for a

More information

HEALTH RECORD REASON FOR THIS VISIT ABOUT YOU ABOUT YOUR SPOUSE HEALTH HABITS EXPERIENCE WITH CHIROPRACTIC

HEALTH RECORD REASON FOR THIS VISIT ABOUT YOU ABOUT YOUR SPOUSE HEALTH HABITS EXPERIENCE WITH CHIROPRACTIC HEALTH RECORD ABOUT YOU REASON FOR THIS VISIT Name Address City State Zip _Home phone Birth date Cell Phone Age Gender Number of children Employer Work address Work phone Occupation Marital Status Social

More information

CONTINUUM CHIROPRACTIC ADULT HEALTH HISTORY FORM

CONTINUUM CHIROPRACTIC ADULT HEALTH HISTORY FORM CONTINUUM CHIROPRACTIC ADULT HEALTH HISTORY FORM Today s Date PERSONAL DATA Legal Name Preferred Name Age Date of Birth Height Weight Home Address City State Zip Home phone ( ) Business Phone ( ) Cell

More information

634 N. STATE STREET, WESTERVILLE OH, (614) 901-WELL

634 N. STATE STREET, WESTERVILLE OH, (614) 901-WELL eas 634 N. STATE STREET, WESTERVILLE OH, 43082 (614) 901-WELL www.abilitychiro.com Name: Age: Date: Address: City: State: Zip Code: Alternate Address: City: State: Zip Code: Cell Phone: ( ) Cell Phone

More information

Considering Your Non-opioid Options for Pain

Considering Your Non-opioid Options for Pain YOUR VALUES YOUR PREFERENCES YOUR CHOICE Considering Your Non-opioid Options for Pain Self-Care, Chiropractic, Physical Therapy, Acupuncture and Pain Rehabilitation 2 Managing Your Pain: Options Pain If

More information

Natural and Integrative Care for PCOS

Natural and Integrative Care for PCOS Natural and Integrative Care for PCOS Maureen Kelly, M.D. Medical Director Society Hill Reproductive Medicine CoFounder The Wellnest 822 Pine Street, Suite 4B, Philadelphia, PA Natural and Integrative:

More information

The Tevis Center for Wellness. Complementary Health. Services

The Tevis Center for Wellness. Complementary Health. Services The Tevis Center for Wellness Complementary Health Services Complementary Health Services Acupuncture Acupuncture is based on the natural laws that describe the movement of life energy, or Qi, in nature

More information

Complementary & Alternative Medicine. Integrative Therapies:

Complementary & Alternative Medicine. Integrative Therapies: Complementary & Alternative Medicine Integrative Therapies: By: Melanie Santos RNIII, BSN, OCN, CMSRN Salinas Valley Memorial Healthcare System Five Branches University Student : March 2019 WHAT IS CAM?

More information

COMMUNITY ACUPUNCTURE A USER GUIDE. Statement of Inclusivity and Ethics

COMMUNITY ACUPUNCTURE A USER GUIDE. Statement of Inclusivity and Ethics Statement of Inclusivity and Ethics Hemma Community Acupuncture strives to create a safe and comfortable environment for all members of our community. We welcome people of all genders, sexes, races, colours,

More information

Use diet and natural supplements to control arthritis pain before resorting to drugs. 4. Maintain a health journal for your dog to record which

Use diet and natural supplements to control arthritis pain before resorting to drugs. 4. Maintain a health journal for your dog to record which Back Pain: Pain Relief Through Holistic Healing, Natural Remedies, Exercise And Nutrition, And Alternative Medicine (Holistic Health Care, Holistic Remedies,... Spinal Cord, Pain Relief, Healing Pain)

More information

Dr. Gary Malstrom B.Sc.(Hon.), D.C., C.Ac Brant Street, Burlington, Ontario L7R 2J9 (905) Fax (905)

Dr. Gary Malstrom B.Sc.(Hon.), D.C., C.Ac Brant Street, Burlington, Ontario L7R 2J9 (905) Fax (905) Dr. Gary Malstrom B.Sc.(Hon.), D.C., C.Ac. Personal History: Name: Address: City: Province: Postal Code: Birth date: day /month /year Age: Sex: M F Home Phone: Business Phone: Cell Phone: E-mail: Health

More information

Complementary Therapies

Complementary Therapies Complementary Therapies August 7, 2018 Together, we can change the course of the HIV epidemic one woman at a time. #onewomanatatime #thewellproject Complementary Therapies Complementary/alternative/integrative

More information

WELCOME TO SOULSTICE WELLNESS CENTRE

WELCOME TO SOULSTICE WELLNESS CENTRE WELCOME TO SOULSTICE WELLNESS CENTRE Name: Date: Age: Birth date: (mm/dd/yr) Address: Residence City Prov Postal Code Primary phone: ( ) Male Female Insurance Company:. Alberta Health Care # E-Mail Occupation

More information

medicine (CAM): group of practices used Alternative medicine: group of practices used as an Integrative medicine: use of conventional medicine in

medicine (CAM): group of practices used Alternative medicine: group of practices used as an Integrative medicine: use of conventional medicine in Chapter 17: Complementary and Alternative Medicine Approaches to Health Care Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products

More information

Natural Balance strives to offer efficacious, holistic, natural health-care, in a personalized, caring and supportive manner.

Natural Balance strives to offer efficacious, holistic, natural health-care, in a personalized, caring and supportive manner. - What do you do at Natural Balance? - What do you treat? - Do you treat children? - Why use a Herbalist? - How fast do these remedies take to work? - Can I take these remedies with these pharmaceutical

More information

Traditional Chinese Medicine

Traditional Chinese Medicine Traditional Chinese Medicine Oriental Medicine (OM) pre-dates modern western medicine by more than a thousand years. It has grown and developed into a comprehensive health care system with a continuous

More information

Personal Information. Reason for Seeking Care. What is your reason for seeking care at Strive Chiropractic?

Personal Information. Reason for Seeking Care. What is your reason for seeking care at Strive Chiropractic? Adult Intake Form Date: Personal Information First Name: M.I.: Last Name: Preferred Name: Social Security Number: Address: City / State / Zip: Cell Phone: ( ) Alternate Phone: ( ) Text Reminders: Y N Before

More information

Diana Quinn, ND Integrative Healthcare Providers 3053 Miller Rd Ann Arbor, MI P (734) F (734) New Patient Intake Form

Diana Quinn, ND Integrative Healthcare Providers 3053 Miller Rd Ann Arbor, MI P (734) F (734) New Patient Intake Form Diana Quinn, ND Integrative Healthcare Providers 3053 Miller Rd Ann Arbor, MI 48103 P (734) 547-3990 F (734) 547-3890 New Patient Intake Form Personal Information Name Age Sex Female Male Gender Identify

More information

Complementary and Alternative Medicine

Complementary and Alternative Medicine Complementary and Alternative Medicine Approaches to Health Care Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not

More information

Adult Health History Summary

Adult Health History Summary Adult Health History Summary Name Age Date of Birth Address City Province Postal Code Phone (home) (cell) Occupation Email May we contact you via email? YES NO Emergency Contact Phone # How did you hear

More information

Principal Benefits for Kaiser Permanente Traditional Plan (10/1/16 9/30/17)

Principal Benefits for Kaiser Permanente Traditional Plan (10/1/16 9/30/17) Benefit Summary SISC-SELF INSURED SCHOOLS OF CALIFORNIA Principal Benefits for Kaiser Permanente Traditional Plan (10/1/16 9/30/17) The Services described below are covered only if all of the following

More information

Name First Middle Initial Last Today s Date. Address Street City State Zip. Primary Phone # Cell # . Your Occupation Employer

Name First Middle Initial Last Today s Date. Address Street City State Zip. Primary Phone # Cell #  . Your Occupation Employer Name First Middle Initial Last Today s Date Address Street City State Zip Date of Birth Age Social Security # Sex: Male Female mm/dd/year Primary Phone # Cell # Email Emergency Contact Name Number Marital

More information

(emergency room pain)

(emergency room pain) Welcome to Moving Body Chiropractic! We re glad you re here. Whether you re looking to work on a specific problem or just feel great, this form is the start to your wellness journey! Please take the time

More information

Informed Consent for Weight Management Treatment & Appetite Suppressants Voluntary Enrollment

Informed Consent for Weight Management Treatment & Appetite Suppressants Voluntary Enrollment Informed Consent for Weight Management Treatment & Appetite Suppressants Voluntary Enrollment I am voluntarily enrolling in an aggressive weight management program. I hereby authorize Dr. Britton and his

More information

First Name Middle Last Today s Date / / Age Male/Female Date of Birth / / SS# - - Address City State ZIP Phone: Home Cell Phone Provider Address

First Name Middle Last Today s Date / / Age Male/Female Date of Birth / / SS# - - Address City State ZIP Phone: Home Cell Phone Provider  Address First Name Middle Last Today s Date / / Age Male/Female Date of Birth / / SS# - - Address City State ZIP Phone: Home Cell Phone Provider Email Address Do you have Medicaid? Y / N (present your card to

More information

Healthy dental coverage Healthy employees A healthy bottom line!

Healthy dental coverage Healthy employees A healthy bottom line! Healthy dental coverage Healthy employees A healthy bottom line! Aetna Dental Products Great dental plans for a healthy workforce 09.03.100.1 H (5/09) We re an industry leader reaching high standards You

More information

Acupuncture for Well Being

Acupuncture for Well Being Acupuncture for Well Being There is sufficient evidence of acupuncture s value to expand its use into conventional medicine. - National Institute of Health, 1997 Consensus on Acupuncture About Me Retired

More information

Principal Benefits for Kaiser Permanente Senior Advantage (HMO) with Part D (10/1/15 9/30/16)

Principal Benefits for Kaiser Permanente Senior Advantage (HMO) with Part D (10/1/15 9/30/16) SISC - SELF-INSURED SCHOOLS OF CALIFORNIA Principal Benefits for Kaiser Permanente Senior Advantage (HMO) with Part D (10/1/15 9/30/16) The Services described below are covered only if all of the following

More information

Primary Health Concerns Please use the following to best describe the primary reason you are seeking medical care today.

Primary Health Concerns Please use the following to best describe the primary reason you are seeking medical care today. Patient Intake Form 30 E. 60 th Street #302 - New York, NY 10022 New Patient Special Consultation Notes: For: (OFFICE USE ONLY) Full Name (First, Last) Date Referral: How did you hear about us? Who should

More information

ABOUT YOU CHIROPRACTIC EXPERIENCE REASON FOR THIS VISIT ABOUT YOUR SPOUSE HEALTH HABITS

ABOUT YOU CHIROPRACTIC EXPERIENCE REASON FOR THIS VISIT ABOUT YOUR SPOUSE HEALTH HABITS NAME: ABOUT YOU WHO REFERRED YOU TO OUR OFFICE? CHIROPRACTIC EXPERIENCE ADDRESS: CITY: HOME PHONE: STATE/ZIP CODE: CELL PHONE: How did you hear about our office? NEWSPAPER SIGN YELLOW PAGES COMMUNITY EVENT

More information

Alternative Health. A New Look at an Old Way. A free report by:

Alternative Health. A New Look at an Old Way. A free report by: Alternative Health A New Look at an Old Way of Life A free report by: http://natural-remediesinfo.com Table of Contents Introduction... 2 Concepts of Eastern Medicine... 2 Combining Alternative Methods

More information

Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SAMPLE GROUP AGREEMENT

Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SAMPLE GROUP AGREEMENT EOC #6 - Kaiser Foundation Health Plan, Inc. Southern California Region Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SAMPLE

More information

Summary of Benefits Chart for Kaiser Permanente Senior Advantage (HMO) with Part D (10/1/17 9/30/18)

Summary of Benefits Chart for Kaiser Permanente Senior Advantage (HMO) with Part D (10/1/17 9/30/18) SISC - KPSA $0 Summary of Benefits Chart for Kaiser Permanente Senior Advantage (HMO) with Part D (10/1/17 9/30/18) Plan Out-of-Pocket Maximum For Services subject to the maximum, you will not pay any

More information

General Chiropractic/Health Information

General Chiropractic/Health Information General Chiropractic/Health Information Chiropractic Over 20 million people receive chiropractic care every year. What is chiropractic? The basis of chiropractic care is detecting and correcting irregularities

More information

Principal benefits for Kaiser Permanente Traditional HMO Plan (10/1/18 9/30/19)

Principal benefits for Kaiser Permanente Traditional HMO Plan (10/1/18 9/30/19) Disclosure Form SISC - Self Insured Schools Of California Home Region: California Principal benefits for Kaiser Permanente Traditional HMO Plan (10/1/18 9/30/19) Accumulation Period The Accumulation Period

More information

Health Net Health Plan of Oregon, Inc. Well Net Supplemental Benefit Schedule CAM /09

Health Net Health Plan of Oregon, Inc. Well Net Supplemental Benefit Schedule CAM /09 Health Net Health Plan of Oregon, Inc. Well Net Supplemental Benefit Schedule CAM33 15-1000/09 Article 1 - Purpose and Function of this Schedule The purpose of this Schedule is to provide coverage for

More information

Your Kaiser Permanente CHIROPRACTIC and ACUPUNCTURE benefits

Your Kaiser Permanente CHIROPRACTIC and ACUPUNCTURE benefits Provided by American Specialty Health Plans of California, Inc. (ASH Plans) Your Kaiser Permanente CHIROPRACTIC and ACUPUNCTURE benefits When you need chiropractic or acupuncture care, follow these simple

More information

Principal benefits for Kaiser Permanente Traditional Plan (10/1/15 9/30/16)

Principal benefits for Kaiser Permanente Traditional Plan (10/1/15 9/30/16) Disclosure Form SISC-SELF INSURED SCHOOLS OF CALIFORNIA Principal benefits for Kaiser Permanente Traditional Plan (10/1/15 9/30/16) The Services described below are covered only if all of the following

More information

CHIROPRACTIC INTAKE FORM

CHIROPRACTIC INTAKE FORM 3885 Duke of York Blvd., Suite C211, Mississauga, ON L5B0E4 T: (905)276-6800 F: (905)276-6802 www.naturawellnessclinic.com CHIROPRACTIC INTAKE FORM DATE: PATIENT INFORMATION Name Sex: M/F Age Date of Birth

More information

Acupuncture for Well Being

Acupuncture for Well Being Acupuncture for Well Being There is sufficient evidence of acupuncture s value to expand its use into conventional medicine. - National Institute of Health, 1997 Consensus on Acupuncture About Me Ho Lim

More information

PERSONAL INFORMATION. First Name: M.I.: Last Name: Preferred Name: Social Security Number: Address: City / State / Zip:

PERSONAL INFORMATION. First Name: M.I.: Last Name: Preferred Name: Social Security Number: Address: City / State / Zip: ADULT INTAKE FORM Date: PERSONAL INFORMATION First Name: M.I.: Last Name: Preferred Name: Social Security Number: Address: City / State / Zip: Cell Phone: ( ) Alternate Phone: ( Text Reminders: Y N Before

More information

Aromatherapist: CLIENT RECORD. Personal Information: Name: D.O.B Occupation: Address: Telephone: Marital Status: Dependents: Doctor: Doctor Informed?

Aromatherapist: CLIENT RECORD. Personal Information: Name: D.O.B Occupation: Address: Telephone: Marital Status: Dependents: Doctor: Doctor Informed? CLIENT RECORD Personal Information: Name: D.O.B Occupation: Address: Telephone: Marital Status: Dependents: Doctor: Doctor Informed? Medical History: What are you doing for your health:(eg Exercise, Diet,

More information

Committed to your Health and Wellbeing because we care."

Committed to your Health and Wellbeing because we care. Committed to your Health and Wellbeing because we care." Stubbington Natural Health Clinic 3 Stubbington Lane Stubbington Fareham PO14 2PP 01329 665871 February 2012 Dear Patient New Homeopath Joins the

More information

Saleeby Chiropractic Centre, P.A.

Saleeby Chiropractic Centre, P.A. Saleeby Chiropractic Centre, P.A. Stephen M. Saleeby, D.C. Wayne J. Prickett, D.C. Today s Date: / / Chiropractic Intake Z: Name: DOB: / / Age: First MI Last Preferred Name: Address City State Zip Code

More information

Extended Health Care Company Do you need any help retaining information about your health insurance coverage? Yes No

Extended Health Care Company Do you need any help retaining information about your health insurance coverage? Yes No PATIENT ENTRANCE FORM Date Circle: Male Female Name Birth Date (dd/mm/yy) Age Address Apt # City Province Postal Code Home # Cell # Work # E-MAIL Occupation Employer Name of Emergency Contact Contact #

More information

Holistic Massage Diploma Assessment Book

Holistic Massage Diploma Assessment Book Holistic Massage Diploma Assessment Book # Contents Contents... 2 Study Tips & Suggestions... 3 Assessment Questions... 5 The Application of Massage... 5 Contraindications & Cautions... 7 The Need for

More information

RAINIER VALLEY CHIROPRACTIC P.S th Avenue S. Seattle, WA 98118

RAINIER VALLEY CHIROPRACTIC P.S th Avenue S. Seattle, WA 98118 Patient Health History Full Name Date Street Address City & State Zip Phone Number Gender Date of Birth Age SSN How did you hear about our office? Marital Status # of Children? Currently Pregnant? / How

More information

SEEDS OF HOPE FAMILY CHIROPRACTIC HEALTH HISTORY

SEEDS OF HOPE FAMILY CHIROPRACTIC HEALTH HISTORY SEEDS OF HOPE FAMILY CHIROPRACTIC HEALTH HISTORY Welcome! PLEASE PRINT CLEARLY PERSONAL DATA Today s Date First name MI: Last name: Nickname Gender M F Age Date of Birth SS# (optional) Current address

More information

MIND-BODY PRACTICES TO MODULATE AUTONOMIC TONE FOR CHRONIC DISEASE MSA COALITION PATIENT & FAMILY CONFERENCE

MIND-BODY PRACTICES TO MODULATE AUTONOMIC TONE FOR CHRONIC DISEASE MSA COALITION PATIENT & FAMILY CONFERENCE MIND-BODY PRACTICES TO MODULATE AUTONOMIC TONE FOR CHRONIC DISEASE MSA COALITION PATIENT & FAMILY CONFERENCE Landrew Sevel, PhD Osher Center for Integrative Medicine at Vanderbilt Department of Psychiatry

More information

Dear Valued Patient, Thanks for allowing me to be a part of your healthcare team! Sincerely, Mary Mees, LAc, DAOM

Dear Valued Patient, Thanks for allowing me to be a part of your healthcare team! Sincerely, Mary Mees, LAc, DAOM Dear Valued Patient, Welcome to Integrated Acupuncture Services! I know that you have many choices when looking for a healthcare practitioner, and I am quite happy that you have chosen me. You can be sure

More information

CHIROPRACTIC EXPERIENCE ABOUT YOU REASON FOR THIS VISIT HEALTH HABITS MEDICATIONS YOU TAKE SUPPLEMENTS YOU TAKE

CHIROPRACTIC EXPERIENCE ABOUT YOU REASON FOR THIS VISIT HEALTH HABITS MEDICATIONS YOU TAKE SUPPLEMENTS YOU TAKE ABOUT YOU CHIROPRACTIC EXPERIENCE NAME: ADDRESS: CITY: HOME PHONE: EMAIL ADDRESS: STATE/ZIP CODE: CELL PHONE: WHO REFERRED YOU TO OUR OFFICE? HAVE YOU SEEN OR HEARD OF OUR OFFICE BECAUSE OF ( ALL THAT

More information

Today s Date: What are your health goals? Symptom relief and preventing its return 100% optimum health and wellbeing on every level available to me

Today s Date: What are your health goals? Symptom relief and preventing its return 100% optimum health and wellbeing on every level available to me Today s : MHSC REGISTRATION # (6 DIGIT) (9 DIGIT) First Name: Last Name: I am a Male/Female (circle) Birthday (d/m/y): / / Current Age: Street Address: City: Province: Postal Code: Home #: Work #: Cell

More information

Acupuncture Health History Page 1 of 5

Acupuncture Health History Page 1 of 5 General Contact Information Acupuncture Health History Page 1 of 5 Name: Date of Birth: Address: City: Postal Code: Contact Numbers#: Home #: Email: (By checking you give David E. Chung Permission to email

More information

Taking Charge, Living Life: Managing Your Chronic Pain

Taking Charge, Living Life: Managing Your Chronic Pain Taking Charge, Living Life: Managing Your Chronic Pain Common Questions & Answers About Chronic Pain Treatment What is your pain like? Goals of Pain Therapy You are not alone! Chronic pain is a very common

More information

Chiropractic Healthcare. What, How, & Why

Chiropractic Healthcare. What, How, & Why Chiropractic Healthcare What, How, & Why Table of Contents Introduction 3 Topics Why Should Anyone go to a Chiropractor? 4 What to Expect on Your First Visit 7 Chiropractic and Exercise: Better than Drugs

More information

Chiropractic , The Patient Education Institute, Inc. amf10101 Last reviewed: 01/17/2018 1

Chiropractic , The Patient Education Institute, Inc.   amf10101 Last reviewed: 01/17/2018 1 Chiropractic Introduction Chiropractic is health care that focuses on disorders of the musculoskeletal system and the nervous system, and the way these disorders affect general health. Chiropractic uses

More information

Complementary therapies

Complementary therapies Complementary therapies There is a lot more to managing epilepsy than just seizure control. A good quality of life is important, and this is where complementary therapies can be most effective. Complementary

More information

CHIROPRACTIC NEW PATIENT FORM REASON FOR VISIT

CHIROPRACTIC NEW PATIENT FORM REASON FOR VISIT FULL NAME: DATE OF BIRTH (DD/MM/YYYY): STREET ADDRESS: PROVINCE: HOME PHONE: (CHECK WHICH PREFERRED) WORK PHONE: EMAIL ADDRESS: NEW LEGISLATION REQUIRES THAT WE OBTAIN CONSENT PRIOR TO SENDING EMAILS TO

More information

Welcome to Manna Family Chiropractic!

Welcome to Manna Family Chiropractic! Welcome to Manna Family Chiropractic! Today s date Who should we thank for referring you here? Is your visit today regarding you, or your whole family? Family Just Me Your name Date of Birth Street Address

More information

AUERBACH CHIROPRACTIC

AUERBACH CHIROPRACTIC AUERBACH CHIROPRACTIC ARTS AND SCIENCE Dr. Gary Auerbach 2730 N. Pantano Road Tucson, AZ 85715 Phone: 520-721-7177 Welcome to the office of Auerbach Chiropractic Arts and Science. In order to better serve

More information

Our Aims and Values TO ASSIST THE COMMUNITY TOWARDS POSITIVE MENTAL HEALTH

Our Aims and Values TO ASSIST THE COMMUNITY TOWARDS POSITIVE MENTAL HEALTH Treatment Portfolio Our Aims and Values 2 TO ASSIST THE COMMUNITY TOWARDS POSITIVE MENTAL HEALTH Bridge of Hope, a department of Ashton Community Trust, promotes mental health and wellbeing by supporting

More information

Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SAMPLE GROUP SAMPLE

Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SAMPLE GROUP SAMPLE EOC #4 - Kaiser Foundation Health Plan, Inc. Northern California Region Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for GROUP

More information

The Two Essential Long Life Exercises Western Doctors, Physios, Coaches And Trainers Will Never Show You

The Two Essential Long Life Exercises Western Doctors, Physios, Coaches And Trainers Will Never Show You The Two Essential Long Life Exercises Western Doctors, Physios, Coaches And Trainers Will Never Show You Matthew Scott Feel free to give this report to anyone you know who wants to live a longer, healthier

More information

Acupuncture , The Patient Education Institute, Inc. amf00102 Last reviewed: 06/23/2017 1

Acupuncture , The Patient Education Institute, Inc.   amf00102 Last reviewed: 06/23/2017 1 Acupuncture Introduction Acupuncture is the practice of inserting thin needles into specific body points to improve health and well-being. It originated in China more than 2,000 years ago. Research has

More information

Chiropractic Case History/Patient Information

Chiropractic Case History/Patient Information Chiropractic Case History/Patient Information 1 Date: Patient # Doctor: Name: Social Security # Home Phone: Address: City: State: Zip: E-mail address: Fax # Cell Phone: Age: Birth Date: Race: Marital:

More information

Chiropractic Case History/Patient Information

Chiropractic Case History/Patient Information Chiropractic Case History/Patient Information 1 Date: Patient # Doctor: Name: Social Security # Home Phone: Address: City: State: Zip: E-mail address: Fax # Cell Phone: Age: Birth Date: Race: Marital:

More information

Pediatric Intake Paperwork. Personal History

Pediatric Intake Paperwork. Personal History Pediatric Intake Paperwork Child s Name: Date: Address: City: Zip: Cell Phone: Work Phone: Email: Date of Birth: Social Security Number: Your occupation: Your employer: Whom to contact in case of emergency?

More information

Fatigue and Chronic Fatigue Syndrome

Fatigue and Chronic Fatigue Syndrome Fatigue and Chronic Fatigue Syndrome Introduction Nearly everyone struggles with being overtired or overworked from time to time. Temporary fatigue usually has a specific cause. It is easily treated. Chronic

More information

An Introduction to Chiropractic

An Introduction to Chiropractic An Introduction to Chiropractic Chiropractic is a health care approach that focuses on the relationship between the body s structure mainly the spine and its functioning. Although practitioners may use

More information

Group ID: Contract: 1 Version: 11 EOC Number: 8. January 1, 2017, through December 31, 2017

Group ID: Contract: 1 Version: 11 EOC Number: 8. January 1, 2017, through December 31, 2017 EOC #8 - Kaiser Foundation Health Plan, Inc. Northern California Region Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for MARSH

More information

Complementary, Alternative, or Integrative Health: What s In a Name?

Complementary, Alternative, or Integrative Health: What s In a Name? Complementary, Alternative, or Integrative Health: What s In a Name? Complementary and alternative medicine, complementary medicine, alternative medicine, integrative medicine we have all seen these terms

More information

Adult Health Questionnaire

Adult Health Questionnaire Health for Life Chiropractic At Cloverdale Mall Unit #143-250 The East Mall Etobicoke, ON, M9B 3Y8 416-232-1822 416-232-0060 Dr. Chrystopher Sly B.Sc, D.C. Dr. Jesse Cracknell B.A., D.C. Adult Health Questionnaire

More information

Complementary and Alternative Therapies

Complementary and Alternative Therapies Complementary and Alternative Therapies Slide 1 1 Complementary and Alternative Therapies Complementary Therapies Therapies used in addition to conventional treatment recommended by the person s health

More information

Patient Introduction (age 13-21)

Patient Introduction (age 13-21) #204, 1740 Gordon Drive Kelowna, BC V1Y 3H2 250-868-4880 www.lifeworkschiropractic.ca wecare@lifeworkschiropractic.ca Patient Introduction (age 13-21) Personal History: Your Name: First (Nick-name) Last

More information

SUMMARY INSTRUCTOR RESOURCES

SUMMARY INSTRUCTOR RESOURCES TRANSITION GUIDE This transition guide serves to outline the updates and new content found in Synovitz and Larson s Consumer Health & Integrative Medicine: A Holistic View of Complementary and Alternative

More information

MASSAGE FEEL THE DIFFERENCE REMEDIAL, SPORTS, RELAXATION, INJURY PROFESSIONAL CHINESE MASSAGE

MASSAGE FEEL THE DIFFERENCE REMEDIAL, SPORTS, RELAXATION, INJURY PROFESSIONAL CHINESE MASSAGE MASSAGE PROFESSIONAL CHINESE MASSAGE FEEL THE DIFFERENCE REMEDIAL, SPORTS, RELAXATION, INJURY ZHONG S UNIQUE MASSAGE EXPERIENCE Dr Jason Zhong Dr Jason Zhong is a western-trained medical doctor and anaesthetist

More information

Describe the pain and it s location:

Describe the pain and it s location: WELCOME TO ZIVKOVIC CHIROPRACTIC CENTER DATE: Please print clearly and fill in completely. ABOUT YOU: Patient Name:_ What do you prefer to be called:_ SS# Street Address City State Zip Date of Birth: Age:

More information

Date: SSN: Birthday: First Name: Middle Name: Last Name: Sex: Male Female Height: Weight: Married/Single: Spouse Name: Home # Cell # Work #

Date: SSN: Birthday: First Name: Middle Name: Last Name: Sex: Male Female Height: Weight: Married/Single: Spouse Name:   Home # Cell # Work # Patient Information: Date: SSN: Birthday: First Name: Middle Name: Last Name: Sex: Male Female Height: Weight: Married/Single: Spouse Name: Email: Home # Cell # Work # Text Appointment Reminders: Yes No

More information

Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SAMPLE GROUP AGREEMENT

Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SAMPLE GROUP AGREEMENT EOC #6 - Kaiser Foundation Health Plan, Inc. Southern California Region Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SAMPLE

More information

Guide to CBD and Essential Oils for Stress Relief, Energy and Vitality

Guide to CBD and Essential Oils for Stress Relief, Energy and Vitality Guide to CBD and Essential Oils for Stress Relief, Energy and Vitality http://www.mindfulmomentum.org Hi, I m! I work with who are tired of hi, Hi, I m Christina. For years I was caught up in a busy cycle

More information

Chiropractic Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SANTA CLARA COUNTY SCHOOLS INSURANCE GROUP

Chiropractic Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SANTA CLARA COUNTY SCHOOLS INSURANCE GROUP EOC #82 - Kaiser Foundation Health Plan, Inc. Northern California Region Chiropractic Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage for SANTA CLARA COUNTY SCHOOLS

More information

CHIROPRACTIC NEW PATIENT FORM REASON FOR VISIT

CHIROPRACTIC NEW PATIENT FORM REASON FOR VISIT DR. ANN IZARD, B.COMM, DC DOCTOR OF CHIROPRACTIC 4353 HASTINGS STREET BURNABY, BC V5C 2J7 TEL: 604.293.2941 FAX: 604.298.2941 WWW.BHIHC.COM WWW.ANNIZARD.COM FULL NAME: DATE OF BIRTH (DD/MM/YYYY): STREET

More information

On a scale of 1 10 ("10" being optimal health) please rate where you feel your health is in the the areas below:

On a scale of 1 10 (10 being optimal health) please rate where you feel your health is in the the areas below: Healthcare History djp Pure-Health wellness centre www.pure-health.com Wellness Profile General Health On a scale of 1 10 ("10" being optimal health) please rate where you feel your health is in the the

More information

WELCOME TO THE MILLER CHIROPRACTIC CLINIC

WELCOME TO THE MILLER CHIROPRACTIC CLINIC WELCOME TO THE MILLER CHIROPRACTIC CLINIC We are pleased that you have chosen to consult us regarding your health. In order to help us evaluate your condition thoroughly, please complete the following

More information

Corner on Wellness Chiropractic Center Therapeutic Massage

Corner on Wellness Chiropractic Center Therapeutic Massage Corner on Wellness Chiropractic Center Therapeutic Massage Patient Name Date Address _ City State Zip Phone Email Emergency Contact Name Phone Employer Work Phone Date of Birth Social Security # Is condition

More information

January 1, 2018, through December 31, 2018

January 1, 2018, through December 31, 2018 EOC #16 - Kaiser Foundation Health Plan, Inc. Northern and Southern California Regions Combined Chiropractic and Acupuncture Services Amendment of the Kaiser Foundation Health Plan, Inc., Evidence of Coverage

More information

The aging population and the case for integrating Manual Osteopathy in the normal healthcare framework. Marinus van Aarle (B.Sc)

The aging population and the case for integrating Manual Osteopathy in the normal healthcare framework. Marinus van Aarle (B.Sc) The aging population and the case for integrating Manual Osteopathy in the normal healthcare framework Marinus van Aarle (B.Sc) National Academy of Osteopathy Research Thesis February 12, 2016 Hypothesis:

More information

Chiropractic Case History/Patient Information

Chiropractic Case History/Patient Information Family Chiropractic and Wellness. 1 Chiropractic Case History/Patient Information Date: Patient # Name: Social Security # Home Phone: Address: City: State: Zip: E-mail address: Fax # Cell Phone: Birth

More information

Name Date / / Age Male/Female Address City State Zip Phone: Home Cell Carrier (Ex: AT&T, Verizon)

Name Date / / Age Male/Female Address City State Zip Phone: Home Cell Carrier (Ex: AT&T, Verizon) Name_ Date / / Age Male/Female Address City State Zip Phone: Home Cell Carrier (Ex: AT&T, Verizon) For reminders do you prefer Phone Calls, Text Messages or Emails? CALL ME / TEXT ME / EMAIL ME Email Address

More information

Chiropractic Case History/Patient Information

Chiropractic Case History/Patient Information 1 Chiropractic Case History/Patient Information Name: Social Security # Home Phone: Address City: State: Zip: E-mail address: Fax # Cell Phone: Age: Birth Race: Marital: M S W D Occupation: Office Phone:

More information

LIST YOUR HEALTH CONCERNS BELOW

LIST YOUR HEALTH CONCERNS BELOW 8209 Natures Way Unit 115 Lakewood Ranch, Florida 34202 (941) 877.1507 Name Date / / Age Male Female Address City State Zip Phone: Home Cell Cell Phone Provider Email Date of Birth / / Employer s Name

More information

An Interview with a Chiropractor

An Interview with a Chiropractor An Interview with a Chiropractor Doctor Scott Warner took the time out of his busy schedule to talk to us about chiropractic medicine what it is, what it isn t, and why he chose it as a profession. What

More information

NPM INTAKE FORM: ADULT INFORMATION: Name: Age: Date:

NPM INTAKE FORM: ADULT INFORMATION: Name: Age: Date: NPM INTAKE FORM: ADULT INFORMATION: Name: Age: Date: Address: City/State/Zip: Home Phone No.: Work Phone No: Cell Phone: Email Address: Gender: Date of Birth: Occupation: Best Time to Contact: Number of

More information

Luker Chiropractic Health Questionnaire

Luker Chiropractic Health Questionnaire Luker Chiropractic Health Questionnaire Name: D.O.B.: Address: City: State: Zip: Home Phone: Cell: Email: Male/Female Marital Status: M W D S Age: SS# Occupation: Employer: Spouse Name: # of Children:

More information

PATIENT NAME DATE CONSULTATION QUESTIONNAIRE

PATIENT NAME DATE CONSULTATION QUESTIONNAIRE CONSULTATION QUESTIONNAIRE 1. What is your major symptom? 2. What does this prevent you from doing or enjoying? 3. If this is a recurrence, when was the first time you noticed this problem? How did it

More information

Cascadia Chiropractic Centre

Cascadia Chiropractic Centre Name: Address: Dr. Simpson Leung Cascadia Chiropractic Centre New Patient Information & Clinical Record Date: City: Province: Postal Code: Phone: Cell: Work Phone: Date of Birth: E-mail Address: Care Card

More information

BOTHELL INTEGRATED HEALTH, LLC Therapeutic Massage

BOTHELL INTEGRATED HEALTH, LLC Therapeutic Massage BOTHELL INTEGRATED HEALTH, LLC Therapeutic Massage Patient Name Date Address City State Zip Phone (home) (cell) Emergency Contact Name Phone Employer Date of Birth Work Phone Social Security # Is condition

More information

This section includes billing guidelines and treatment information for alternative care providers including:

This section includes billing guidelines and treatment information for alternative care providers including: Alternative care Alternative care overview This section includes billing guidelines and treatment information for alternative care providers including: Acupuncturists/East Asian Medicine Practitioners

More information