Online Forms

North Florida Rehab and Chiropractic, LLC offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • If you do not already have AdobeReader® installed on your computer, click here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Email or Fax us your printed and completed form(s) or bring it with you to your appointment.

**You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
● You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes
related costs like medical tests, prescription drugs, equipment and hospital fees. This can be done over the phone if less than three days before the visit.
● Make sure your healthcare provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item if scheduled more than three days in advance. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
● If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
● Make sure to save a copy or picture of your Good Faith Estimate. 


New Patient Accident Forms

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Self Pay/Insurance Forms

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Location

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HOURS OF OPERATION

Monday, Wednesday

9:30 am - 6:00 pm

Tuesday

12:00 am - 4:00 pm

Thursday

By Appointment

Friday

9:30 am - 5:30 pm

Saturday, Sunday

Closed

Monday, Wednesday
9:30 am - 6:00 pm
Tuesday
12:00 am - 4:00 pm
Thursday
By Appointment
Friday
9:30 am - 5:30 pm
Saturday, Sunday
Closed