Serving Kettering and the Dayton Metro Area | 937-298-5987

Complete chiropractic healthcare for adults and children

Kettering Chiropractic Center - Logo Couple

Forms for Your First Visit

To make your first visit more efficient, please download, print, and fill out the following forms before your visit. Patient Information Form, Patient Symptom Form, and Patient Health Consent Form.

Group or individual health insurance

We attempt to take out as much of the ‘insurance hassle’ as possible for you. We’ll happily contact 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 insurance 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 your financial responsibilities at our office, please do not hesitate to ask. Our insurance department has many years of experience and will be happy to assist you.

Patients without insurance

For patients who do not have health insurance, or have plans with limited coverage, such as catastrophic policies, we realize that no one wants to build up a large bill balance. Therefore, we have several plans so that these patients may receive complete care without undue financial difficulty. Of course, we are always happy to accept cash, your personal check, MasterCard, Visa, American Express, or Discover cards.

Kettering Chiropractic Center is here to treat a broad range of your symptoms using modern techniques.

Speak to a member of our friendly staff and schedule your first visit.


On-the-job injuries

If you are injured on the job, your care should be paid for under your employer's workers' compensation insurance. You will need to inform your employer of the accident and obtain the name and address of the carrier of their insurance. If your employer does not provide us with the information, or if a settlement has not been made within 3 months, or if you suspend or terminate care, any fees for services are due immediately.

Be prepared before your first appointment.

Personal injury or automobile accidents

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 you suspend or terminate care, any fees for services are due immediately.


We do not accept assignment from Medicare. As a service for patients, we will file all forms, but are not Medicare providers. By Medicare contract, we have a reduced, fixed charge per office visit adjustment.

Secondary insurance

Please inform us of any secondary insurance you may carry. We will assist you if you need help in filing this paperwork.

Woman Worker's compensation