Online Forms

Patient Forms

Please use the following links to print and fill out our insurance coverage and patient health history forms. The forms are in the PDF format; in order to view them you will need a PDF viewer such as Adobe Reader. If you do not have Adobe Reader you can click here to download it FREE.

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Fax us your printed and completed form(s) or bring it with you to your appointment.

For New Patients:

New Pediatric Patients:
Ped. Paperwork AOTC

New Auto Accident Patients:
NP Paperwork Auto AOTC

New Patient History:
NP History Paperwork AOTC

For New Massage Patients:
NP Massage Paperwork AOTC


GROUP OR INDIVIDUAL INSURANCE
We attempt to take out as much of the “insurance hassle” as possible for you. We’ll happily telephone your insurance company to verify your coverage benefits. Please remember, however, that the benefits quoted to us by your insurance company are not a guarantee of payment. We will file your claim and await payment for 90 days. If your company pays the benefits they quote to us, the only services you will be responsible for are any non-covered services, deductibles or co-pays. If you have any questions at all regarding you financial responsibilities at our office, please do not hesitate to ask. Our insurance clerk has years of experience and will be happy to assist you.

PATIENTS WITHOUT INSURANCE
An increasing number of patients do not have insurance, or have plans with limited coverage, such as catastrophic policies. We realize that no one wants to build up a large bill. Therefore, we are apart of ChiroHealthUSA, which offers several plans and Cash Discounts so those patients may receive complete care without undue financial difficulty. Of course we are always happy to accept cash, your personal check, MasterCard, Visa or Discover cards.

“ON THE JOB” INJURY (Worker’s Compensation)
If you are injured on the job, your care should be paid for under your employer’s Worker’s Compensation insurance. You will need to inform your employer of the accident and obtain the name and address of the carrier of their insurance. If your employer does not provide us with this information, if a settlement has not been made within 3 months, or if you suspend or terminate care, any fees and services are due immediately.

PERSONAL INJURY OR AUTOMOBILE ACCIDENTS
Please notify your auto insurance carrier of your visit to our office immediately. Notify our insurance department immediately if an attorney is representing you. Although you are ultimately responsible for your bill, we will wait for settlement of your claim for up to six months after your care is completed. Once the claim is settled or if you suspend or terminate care, any fees for services are due immediately.

MEDICARE
Currently, we do not accept assignment from Medicare. Most of our services are non-covered anyways, as they ONLY partially cover manual manipulation of the spine.

SECONDARY INSURANCE
Please inform us of any secondary insurance you may have. We will assist you if you need help in filing.



Download the Free AdobeReader®

Location

Office Hours

Our Regular Schedule

Monday:

10:00 am-1:00 pm

3:00 pm-6:00 pm

Tuesday:

10:00 am-1:00 pm

Admin Hrs.

Wednesday:

10:00 am-1:00 pm

3:00 pm-6:00 pm

Thursday:

Admin Hrs.

3:00 pm-6:00 pm

Friday:

10:00 am-1:00 pm

Admin Hrs.

Saturday:

10:00 am-12:00 pm

Sunday:

Closed

Testimonials

Reviews By Our Satisfied Patients

  • "She is very kind, well-spoken and extremely knowledgeable. If you follow her advice, you will surely see results."
    Shaeron M. / DALLAS, TX
  • "I came to Dr. Hines with misc. aches and pains: back pain (lower and mid), and pain in my left knee. At its worst, I had to stop my workouts due to not being able to handle the pain. I mostly tried OTC pain killers, prescription pain killers, and even bought a new mattress. I could not stand to get through my workouts anymore. I came home every day from work and layed around, unable to do much because of the pain. A friend from church told me about Ahead of the Curve Chiropractic, and I have little to no back pain now. Being more aligned has increased my body's ability to heal itself, I have more energy, and I can work out for over an hour at a time, with no pain. Dr. Hines has given me many tips to improve my overall health, which has been very helpful. Dr. Hines is extremely knowledgeable about chiropractic. She is very thorough and genuinely seeks to help her patients' quality of life."
    Christina B., DALLAS, TX