Patient Intake Form (Adult)

PEDIATRIC INTAKE FORM

(Please select the appropriate form based on your child’s age)
Pediatric Intake Form Birth to 2 months
Pediatric Intake Form 2 months to 2 years
Pediatric Intake Form 3 years to 5 years
Pediatric Intake Form 6 to 12 years

Chiropractic Health Solutions is a provider for Anthem BC/BS, Humana, Aetna, Cigna, United Health Care, Bluegrass Family Health, Conseco, Unicare, First Health, Medicare and Medicaid of Kentucky.  In addition, you may contact CareCredit directly to apply for special financing plans.  Care Credit provides low-payment options for healthcare services for your whole family.