AUTO ACCIDENT/PERSONAL INJURY

Due to the sometimes lengthy and complicated nature of auto accident and personal injury cases, the following information is very important and should be read and understood thoroughly prior to any appointment. You will be required to sign a copy for your file.

Brower Chiropractic Center AA/PI Office Policy

Brower Chiropractic Center and Dr. Jeffrey Brower will accept you as a personal injury patient based on our clinical examination and our belief that chiropractic care will be an effective treatment of your injuries.

Your responsibility to this office will be to follow Dr. Brower's recommendations and to provide us with the appropriate financial information so that payment for services can be billed on your behalf and payment received by this office for services rendered.

This office extends credit during treatment and up to 90 days after being released from care to pre accident status. After 90 days the total amount due then becomes the responsibility of the patient to pay in full. At the time of release from treatment you wil be required to provide this office with valid credit card information so that we may charge the amount due after the 90 day grace period has ended.

If you do not wish to provide this information you may opt to pay for services at the time of service for each visit and a receipt will be provided to you so that you may submit the bills to the auto insurance company yourself. This office will NOT bill the insurance at any time.

Additionally this office WILL NOT disclose any financial information, written or verbal, with patients until claims are paid or you have opted to pay at the time of service. This information will only be released to the liable insurance company(s) and/or attorney(s).

After 30 days from release,if not paid your account will be assessed a 1.5% monthly finance charge. If an insurance does not pay for this charge it is the patient's responsibility.