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Dr. Theresa Smith, DC

Forms and Frequently Asked Questions (FAQ)

 

 

Patient Forms

Please print and complete your Chiropractic and Nutrition patient forms before you come into the office.  Please fill out your M.A.P. Pre-Coaching questionnaire and consent form and email prior to your appointment.

Chiropractic Forms

ZONE-NEW-PATIENT-PAPERWORK.pdf

Pain Map Chart

M.A.P. Coaching Forms

Pre_Coaching_Questionaire.pdf

Client_Consent_Form.pdf

Nutrition Forms

Symptom-Survey.pdf

APPOINTMENTS

24 hours cancellation is required or full payment for services to be rendered is due.

INSURANCE

This office does not bill insurance.  We are happy to provide a Superbill for you to submit.  Not all services are covered by insurance.

PRICING

Adjustments are $85.

M.A.P. Coaching is $125 for a 45-minute session. When sessions run beyond 60 minutes, each 15 minutes is $40.  M.A.P. Coaching is available via Zoom.

PEMF Therapy is $40 for 15 minutes; $75 for half hour; $125 per hour.

Nutritional evaluations are $75 per half hour.  A full nutritional evaluation usually takes two hours.