New Patient Forms

Please print, fill out and bring with you to your initial visit.

​​No Insurance Necessary​

At Ultimate Health and Rehab, we require payment at the time of service by all patients.    We do not bill insurances.  However, we can supply you the information needed in order for you to get reimbursed by your insurance if you have chiropractic coverage included in your insurance plan.  This information can be submitted in order to be applied to your deductible also.  We have determined that many insurances have a co-pay at or higher than our treatment fee or they have such a high deductible that it will not be reached in the typical 6 to 10 visits it takes to resolve a complaint.  Strict insurance guidelines frequently have a negative impact on the care we can provide to our patients.  This limitation is unacceptable to us as we strive to provide only the best care for our patients.

Fee Schedule

We accept HSA Healthcare and Flexible Spending accounts. We also offer military and student discounts with a valid ID (25% off exam and all treatment visits, excluding maintenance/preventative ART sessions; can not be combined with any other offer)

Initial Exam....................................$99*

Follow-Up......................................$45*

Sports Physicals............................$20

Personal Runner Coaching............$50/month          

(minimum 4 month up-front commitment)

Preventative/Maintenance
ART sessions................................$35*

Get $30 off your first visit.

* These prices include the "Time-of-Service" discount and are paid at time of service instead of through a 3rd party payer.