New Patient Forms at
Andover Family Chiropractic
Save time during your first visit
At Andover Family Chiropractic, we offer our paperwork online so you can complete it in the convenience of your own home. If you have any questions or concerns, please feel free to call us at (316) 733-0715.
Download & Print Forms. Bring completed forms to the office during your first appointment.
The government requires we post a copy of our Notice of Privacy Policy and Notice of Material Changes to our Privacy Practices Policy.
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call (316) 462-5000.