New Patient Forms
We utilize online intake forms which are located in the hyperlinks below. Please complete prior to your appointment, or plan on arriving 20 minutes prior to your initial appointment to complete.
Child Intake Form (Birth to 5 Years)
Adolescent Intake Form (6 Years - 15 Years)
In addition to the Adult intake listed below; please also complete the Financial Agreement, HIPAA, and Consent. At this time the Adult Intake Form is not supported by Android mobile browsers.
Adult Intake Form (16 Years +)
Financial Agreement, HIPAA, and Consent
______________________________________________________________________________________________
Please complete the acupuncture consent form below if you will be receiving acupuncture treatment from Dr. Miranda in our office.
Acupuncture Consent Form
Child Intake Form (Birth to 5 Years)
Adolescent Intake Form (6 Years - 15 Years)
In addition to the Adult intake listed below; please also complete the Financial Agreement, HIPAA, and Consent. At this time the Adult Intake Form is not supported by Android mobile browsers.
Adult Intake Form (16 Years +)
Financial Agreement, HIPAA, and Consent
______________________________________________________________________________________________
Please complete the acupuncture consent form below if you will be receiving acupuncture treatment from Dr. Miranda in our office.
Acupuncture Consent Form
Insurance Information
The doctors at Aurora Chiropractic are in network with the following insurance companies:
We are not in network with Mayo Medica Health Plan or some Aetna plans.
There may be others that qualify for coverage so please call our office if you have questions. For coverage to be considered for insurance reimbursement it must be related to an acute musculoskeletal complaint. Maintenance care is not covered by insurance companies.
For pediatric and adolescent chiropractic care time-of-service discount rates are available. The majority of the cases we see in our office do not meet medical necessity requirements set by insurance companies. Complaints most commonly seen in our office include: colic, ear infections, gastrointestinal issues, sleeping and/or nursing difficulties, and care related to tongue and lip tie revisions. If treatment is sought out for a musculoskeletal reason (such as torticollis) then we can likely bill insurance. Certain insurance policies may also restrict pediatric care as well making reimbursement even more challenging.
We would be happy to answer any specific questions related to insurance coverage at (507) 625-1085.
- Blue Cross Blue Shield
- Medica
- United Health Care
- Health Partners
- Preferred One
- Medicare
We are not in network with Mayo Medica Health Plan or some Aetna plans.
There may be others that qualify for coverage so please call our office if you have questions. For coverage to be considered for insurance reimbursement it must be related to an acute musculoskeletal complaint. Maintenance care is not covered by insurance companies.
For pediatric and adolescent chiropractic care time-of-service discount rates are available. The majority of the cases we see in our office do not meet medical necessity requirements set by insurance companies. Complaints most commonly seen in our office include: colic, ear infections, gastrointestinal issues, sleeping and/or nursing difficulties, and care related to tongue and lip tie revisions. If treatment is sought out for a musculoskeletal reason (such as torticollis) then we can likely bill insurance. Certain insurance policies may also restrict pediatric care as well making reimbursement even more challenging.
We would be happy to answer any specific questions related to insurance coverage at (507) 625-1085.
