Dr. MacAdam & Associates
  • Services
    • Chiropractic >
      • Techniques and Therapies
      • Custom Orthotics & Footwear
    • Massage Therapy >
      • Massage Therapy Treatment Options
    • Naturopathic Medicine >
      • Vitamin & Nutrient Injections
    • TCM Acupuncture
    • Yoga
    • Mental Performance
  • SHOP
  • Book An Appointment
  • Patient Intake Forms
    • Chiropractic, Massage & Acupuncture
    • Naturopathic >
      • Adult Intake Form
  • Meet Our Team
    • Chiropractors >
      • Dr. Katherine MacAdam, BScKin, DC, MSc, ACC, FCCSS(C).
      • Dr. Maggie McKeough BSc, DC, Medical Acupunture
    • Massage Therapists >
      • Laura Dwyer, RMT
      • Cassie Hilani, RMT
      • Adam Blackwood, RMT
      • Morgan Nearing-Deveaux, RMT
    • Naturopathic Doctor >
      • Dr. Cassandra Connolly, BSc, ND
    • Acupuncturist >
      • Nicole Stallard, RAc, DAc
    • Reception Staff
  • FAQs
  • Contact
  • Gallery
  • Videos
  • Excercises

    Personal Information (**For chiro, massage, acupuncture, and foot care only**)

    ​(New NATUROPATHIC PATIENTS will be sent a form by Email - do not complete this form if you are seeing an ND only)

    MM/DD/YYYY

    Emergency Contact


    Health Information


    Insurance

    In order to direct bill your insurance company on your behalf we require a credit card be left on file.

    Credit Card Information

    MM/YYYY

    Health History


    Please check current or previous problem/concerns:





    Family History


    Females Only


    Reason for Todays Visit


    Financial and Cancellation Policy

    FEE FOR SERVICE
    WE ARE A FEE FOR SERVICE FACILITY AND WE REQUIRE PAYMENT AT THE TIME OF YOUR VISIT, APART FROM A LIMITED NUMBER OF COMPANIES FOR WHICH DIRECT BILLING IS AVAILABLE. MANY SERVICES ARE COVERED WHOLLY OR PARTIALLY BY THIRD PARTY INSURANCE; HOWEVER, ULTIMATELY IT IS THE RESPONSIBILITY OF THE PATIENT TO ENSURE PAYMENT IS MADE AT TIME OF SERVICE. OUR RECOMMENDATIONS FOR CARE ARE BASED UPON OUR DESIRE TO SEE YOU GET AND STAY WELL, DESPITE YOUR LEVEL OF COVERAGE. INSURANCE PLANS OR COVERAGE MAXIMUMS ARE IN NO WAY RELATED TO YOUR HEALTH BUT RATHER ARE FUNCTIONS OF A FINANCIAL ARRANGEMENT BETWEEN YOU AND YOUR INSURANCE PROVIDER.

    PRIVATE INSURANCE COVERAGE
    YOUR INSURANCE POLICY IS A CONTRACT BETWEEN YOU AND YOUR INSURANCE COMPANY, NOT BETWEEN YOUR INSURANCE COMPANY AND OUR OFFICE. PLEASE TAKE THE TIME TO VERIFY YOUR COVERAGE FOR CHIROPRACTIC, MASSAGE THERAPY, ORTHOTICS, NATUROPATHY AND/OR TCM, WITH YOUR INSURER BY CONTACTING THEM PRIOR TO YOUR FIRST VISIT. PLEASE INQUIRE ABOUT AND OBTAIN ANY SPECIFIC INSURER MEDICAL PRESCRIPTIONS FOR SERVICE. IF YOU ARE CHOOSING TO SUBMIT RECEIPTS FOR REIMBURSEMENT WE WILL PROVIDE YOU WITH APPROPRIATE PAYMENT RECEIPTS FOR YOUR REIMBURSEMENT EITHER AT EACH VISIT OR AFTER MULTIPLE APPOINTMENTS DEPENDING ON YOUR PREFERENCE.

    DVA/RCMP
    DIRECT BILLING IS CURRENTLY OFFERED TO DVA/RCMP PATIENTS. IF YOU EXHAUST YOUR COVERAGE PRIOR TO AUTHENTICATION OF AN EXTENSION REQUEST, THEN YOU ARE RESPONSIBLE FOR ANY OF YOUR SERVICES RECEIVED OUTSIDE OF YOUR ORIGINAL COVERAGE. IF FOR ANY REASON DVA OR RCMP WILL NOT APPROVE YOUR CLAIM YOU SHALL ULTIMATELY BE RESPONSIBLE FOR ALL CHARGES

    MOTOR VEHICLE ACCIDENT PATIENTS
    IN ORDER TO PROVIDE DIRECT BILLING SERVICE UNDER NOVA SCOTIA MOTOR VEHICLE ACT YOU MUST ABIDE BY THE REQUIREMENTS OF THE APPROVED SECTION B PROTOCOLS, WHICH MAY INVOLVE EXHAUSTION OF YOUR PRIVATE INSURANCE COVERAGE (DEPENDING ON INDIVIDUAL CIRCUMSTANCES). IF FOR ANY REASON YOUR MOTOR VEHICLE INSURER WILL NOT ACCEPT YOUR CLAIM YOU SHALL ULTIMATELY BE RESPONSIBLE FOR ALL CHARGES.

    WORKER'S COMPENSATION BOARD
    IF YOU ARE INJURED ON THE JOB, YOU WILL NEED TO INFORM YOUR EMPLOYER OF THE ACCIDENT AND OBTAIN A WCB CLAIM NUMBER. IF FOR ANY REASON WCB WILL NOT ACCEPT YOUR CLAIM YOU SHALL ULTIMATELY BE RESPONSIBLE FOR ALL CHARGES.

    For your convenience, we accept the following forms of payment:
    Exact Cash, Debit, Visa, MasterCard

    Initial Chiropractic Assessment  $110
    Chiropractic Appointment  $65
    Chiropractic Appointment &
    Acupuncture, Dry Needling, Modalities $75
    Re-Examination (New Complaint)  $85

    30 minute Massage  $63.50
    45 minute Massage  $79.50
    60 minute Massage  $95
    90 minute Massage  $160





    Initial Naturopathic Assessement  $180
    Naturopathic Follow-up Appointment  $95
    Naturopathic Acute Appointment $55
    B12 Injection $25
    Prolotherapy $30 + visit fee
    Neuroprolotherapy $25 + visit fee
    IV Infusion Therapy please inquire (depends on type)

    Yoga  $100

    Orthotics  $400
    Orthotic Footwear $500
    CANCELLATION POLICY

    We always seek to respect your valuable time by remaining on time and we ask that you respect the time we are holding for you in the same manner.

    IF YOU NEED TO CANCEL OR RESCHEDULE YOUR APPOINTMENT, WE REQUIRE 24 HOURS NOTICE, OTHERWISE YOU WILL BE CHARGED FOR THE FULL AMOUNT OF THE APPOINTMENT We hope you understand the hardship our practitioners face in the event of a no show or last-minute cancellation.

    When booking an appointment, we require a credit card be left on file to process payments. On the day of your appointment once your insurance has been processed we will run your credit card and email you the receipt to you.

    I understand and agree that health/accident insurance policies are between an insurance carrier and myself. I understand and agree that all services rendered to me and charged are my personal responsibility for timely payment. I understand that if I suspend or terminate my care/treatment any fees for professional services rendered to me will be immediately due and payable.

    By clicking submit you are agreeing to the above stated terms and conditions.

Submit
Site powered by Weebly. Managed by Stormweb Hosting
  • Services
    • Chiropractic >
      • Techniques and Therapies
      • Custom Orthotics & Footwear
    • Massage Therapy >
      • Massage Therapy Treatment Options
    • Naturopathic Medicine >
      • Vitamin & Nutrient Injections
    • TCM Acupuncture
    • Yoga
    • Mental Performance
  • SHOP
  • Book An Appointment
  • Patient Intake Forms
    • Chiropractic, Massage & Acupuncture
    • Naturopathic >
      • Adult Intake Form
  • Meet Our Team
    • Chiropractors >
      • Dr. Katherine MacAdam, BScKin, DC, MSc, ACC, FCCSS(C).
      • Dr. Maggie McKeough BSc, DC, Medical Acupunture
    • Massage Therapists >
      • Laura Dwyer, RMT
      • Cassie Hilani, RMT
      • Adam Blackwood, RMT
      • Morgan Nearing-Deveaux, RMT
    • Naturopathic Doctor >
      • Dr. Cassandra Connolly, BSc, ND
    • Acupuncturist >
      • Nicole Stallard, RAc, DAc
    • Reception Staff
  • FAQs
  • Contact
  • Gallery
  • Videos
  • Excercises