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In Loving Memory of Beth & Bill
The Coppell Wellness new Patient Center
Coppell Wellness New Patient forms

To assist us in getting down to the business of helping you, please print these forms, fill them out, and bring them with you on your initial visit:

New Patient forms

Insurance Verification Form

HIPAA Patient Consent Authorization Form

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.

Get Adobe Reader

What can you expect from your first visit?

During your first visit, we will review your medical history and discuss any current concerns you may have. This thorough examination, includes posture and gait analysis, joint and muscle testing and, if necessary X-rays. Based on the outcome of your exam, the doctor will formulate a diagnosis and individualized treatment plan. If it is determined that yours is not a chiropractic case, you may be referred to another health care professional.

Your treatment plan with consists of four phases:

The Relief Phase, when your symptoms are most intense, is designed to reduce these symptoms and inflammation. This may involve other therapies, such as electronic muscle stimulation, ultrasound and massage therapy, to relieve pain and promote faster recovery.

The Corrective Phase helps you achieve increased function and mobility after your symptoms are either gone or significantly improved.

The Rehabilitative Phase focuses on strengthening the spinal structures in their proper positions and ensuring that correction is maintained. In this phase, you should see increased strenth and mobility, as well as increased energy and function.

The Wellness Phase occurs when you have achieved optimal health. At this point, you may choose to schedule periodic Chiropractic care to help maintain health and prevent new injuries.

Do you take 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. Listed below are the insurance companies with which we currently participate.

Covering the cost of medical care is a concern for everyone. Unfortunately, we are not a Medicare Provider, but would be glad to provide you with a letter that will allow you to submit charges directly to Medicare and/or supplemental insurance.

We do accept cash, checks, most credit cards and HSA credit cards for payment. If needed, we offer flexible payment plans, including cash discounts. If you have questions about your insurance coverage, we will check your benefits and explain in detail all that is covered.

We offer a Free Chiropractic Consultation and to meet our great team. Once we've had a chance to do a thorough examination, we can discuss the best treatment plan for you and various payment options.


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 have several plans so those patients may receive complete care without undue financial difficulty.

We offer a “Wellness Package” visit that incorporates both the chiropractic adjustment and muscle mobilization work. These two services will offer the maximum benefit for your health and in order to encourage you to receive both we offer the special package price of only $65 for both services. Call today to take steps toward better health.


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.

Please note we do not accept assignment from Medicare at this time; we can provide you with an Opt Letter for your personal filing process.