Ebling Chiropractic
Dr. Carrie Ebling
Functional Medicine and Therapeutic Massage (OR Lic.# 8058)
Elemental Medicine
2915 SE Belmont Street
Portland, OR 97214
ph: 503-505-9677
eblingch
Forms:
Print and complete your paperwork prior to your first visit to save time.
Fees:
If you pay in full at the time of your visit you will receive at least a 30% discount on all services.
Students also receive an additional 20% off the Time of Service Fees.
Insurance:
I accept most insurance or will provide you with the necessary paperwork for you to obtain reimbursement. I do ask that I have 24 hours to verify the particulars of your policy prior to the initial visit. Verification is no guarantee of payment. and you the patient are ultimately responsible for all charges.
Fees:*
Time of Service:
If you pay in full at the time of your visit your charges are as follows:
Initial Visit $110
- History of your issue.
- Exam of one main problem area.
- Diagnosis.**
- Treatment: Chiropractic Manipulation to the problem area and either soft tissue massage (15 min.) or one modality (Electric Stimulation, Cold Laser, Ultrasound,Therapeutic Exercise).
Return Visits
- $60 for 30 minutes
- $85 for 45 minutes
- $110 for 60 minutes
*Additional charges may apply based on the level of care required and will be disclosed prior to rendering treatment.
**If I do not think I can help you, the charge for the visit will be $30, not $110 and I will refer you to the appropriate specialist.
Missed Appointments:
There is a $30 charge for cancellations within 24 hours of your scheduled appointment time.
Forms:
New patients can download these forms to complete prior to your initial visit. Click on the underlined links below and print out. Please complete them as thoroughly as possible, as this information is valuable for Dr. Ebling to provide the most appropriate care for you. They are 6 pages long.
Print and complete these forms ONLY if you were in a passenger vehicle accident and wish to file a Personal Injury Claim.
New Patient Registration
These form provides the office with all of your contact information, outlines the financial obligations and is the consent form to treat minors. Your Health History is part of this packet. By completing this information, your current area of complaint will be outlined, as well as a brief history of your past injuries, illnesses, medications and accidents. Also included is the privacy policy and the consent to treat form.
If you wish to have the office bill your insurance, you may wish to have us call and have your benefits verified prior to your first visit to ensure coverage. Prior authorization is not a guarantee of payment, and you the patient will ultimately be responsible for all charges incurred. You may submit your insurance information at elementalmedicinepdx.com on the forms and fees page
Copyright 2009 Ebling Chiropractic. All rights reserved.
Elemental Medicine
2915 SE Belmont Street
Portland, OR 97214
ph: 503-505-9677
eblingch
