New Patient
Information and Forms
We welcome people to experience health care from a different point of view. No matter your current health concerns or status, we can
achieve more in partnership helping you to activate your inner healing response to improve your function and performance naturally. Our purpose is to perform care together using the highest ethics, integrity, and professional standards, never ceasing to improve at every level.
If this is your first visit to Park County Chiropractic, the first step in this process is completing the New Patient Intake Form, which can be done in the comfort of your home by clicking on the link for this form from the New Patient Forms area below.
If you need to make an appointment call, 406.222.9373 and speak with reception. They will help find a day and time for an appointment that fits into your schedule.
For your first visit, we ask the following:
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Arrive on time. This ensures enough time to address your concerns, preform an examination, and evaluate the problem, and if appropriate, provide treatment. So that the highest quality care is given to you, we reserve the right to reschedule the appointment if you are more than 15 minutes late.
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When applicable, please bring copies of previous tests like X-rays or MRI reports, blood work, hormone panels, etc.
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Wear comfortable and loose clothing as your care might require some active movement. Dr Dobelbower may need access to your shoulders, knees, neck, etc. If the appointment is for an infant, dress them in an easy-to-remove onesie or outfit.
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Come focused on health and recovery and our journey together. We request that you turn off your phone ringer, bring questions to your appointment, and be ready to talk honestly with Dr Dobelbower about your overall health.
We look forward to being your partner in health!
Welcome!
New Patient Form - Children 0-12
New Patient Form - Nutrition Visit
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Does Dr Dobelbower work with Sports and Performance Patients?Absolutely! Dr Dobelbower is currently certified in SFMA and working towards his Rehab to Performance certification...and he loves helping all of us be better at whatever movement and athletics we want to do. From Ballerinas to Baseball players, Dr Dobelbower focuses on fundamental movement patterns and looks to improve your performance no matter what age or stage of ability you are in. There is always something we want to be better at! We also provide sport physicals for our young athletes including a Functional Movement Screen. A Functional Movement Screen gives Dr Dobelbower a baseline should a young athlete have an injury or problem taking them out of play. A follow up screen can help determine when the athlete is ready to return to sport safely.
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Do you work with my Insurance?We are happy to fill out claim forms and send them to your Major Medical insurance company. However, we do not participate in any provider network. We require you to pay after services have been provided each session. Your insurance company will reimbruse you directly under your out of network policy. We are happy to help you understand your chiropractic benefits or answer questions about your out of network benefits when possible. ***We do accept Medicare and Healthy Montana Kids policies. Personal Injury, Auto accident, and Workers' Compensation claims are accepted on a by case bases.***
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Fees for the Services Park County Chiropractic ProvidesOur fees are: New Patient Examination/Evaluation for Chiropractic, Rehab, or Nutritional: $50-$70 New Patient Nutritional Evaluation: $80 Re-Exam Chiropractic, Rehab, Nutritional: $25-$60 Sports Physical for New Patient: $50 Existing Patient: $35 Phone consultation for Nutritional Consulting or Functional Performance: $30 per 30 mins Chiropractic Adjustment Treatment: $50 Rehabilitation and Functional Training Service: $25 per therapy Ultrasound Therapy: $25 Taping Therapy: ~$8-$45 Other therapy Supplies and Nutritional/Herbal Supplements are available at a range of costs. We endeavor to supply the highest quality for the best value. Ask at the front desk if you have any questions about our fees or if you need help understanding how Medicare, Healthy Montana Kids, Major Medical Insurance, Personal Injury, Workers' Compensation work. We are happy to help you understand. If you truly need financial assistance, talk with Dr Dobelbower during your visit. While we cannot change your financial situation, we can usually find a way to make care a possibility.
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What is the Reschedule Policy?Your appointment is scheduled specifically for you! When you reschedule with late notice, not only are you missing out, other people are too. So that we can take especially good care of everyone, be sure to give 24 hours notice when you need to reschedule an appointment. We reserve the right to charge for non-emergency late reschedule or missed appointments.
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Do you take Medicare? What about Healthy Montana Kids? And Medicaid?We accept payment from Medicare and Medicare Supplemental policies. Please understand you may be responsible for deductible, co-payment, and non-covered services provided to you after the treatment is performed that day. Medicare does not cover every treatment that could be necessary for your care. We make every effort to provide the highest quality care without breaking the bank. We do not accept payment or submit claims for Medicare Part C plans. Healthy Montana Kids policies vary and you may be responsible for a co-pay or be responsible to pay for non-covered services provided to your child after the treatment provided that day. Again we make every effort to provide the highest quality care without breaking the bank. Medicaid for Adults in Montana does not provide coverage for adults. However, if care is for a child under Healthy Montana Kids policy see above.
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Do you Provide Good Faith Estimates?Yes we sure do. Park County Chiropractic Good Faith Estimate Notice Under Section 2799B-6 of the Public Health Service Act, health care providers are required to inform individuals who are not enrolled in a plan or coverage or a Federal healthcare program, or not seeking to file a claim with their plan or coverage both orally and in writing of their ability, upon request or at the time of scheduling health care items and services, to receive a ‘Good Faith Estimate’ of expected charges. Your Rights * You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care 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, and equipment. * You have a right to receive a Good Faith Estimate in writing at least 1 business day before you receive care or a medical service or item. You can also ask your health care provider, 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 through the patient-provider dispute process. Learn more at: https://www.cms.gov/nosurprises/consumers/new-protections-for-you * You have a right to obtain a written copy of the Good Faith Estimate. You may also take a photocopy. For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
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What is Your HIPAA Policy?HIPAA Notification Park County Chiropractic believes in protecting your private health information and we are in accordance with the Health Insurance Portability and Accountability act of 1996 (HIPAA). If you would like to have the full privacy policy, it is available for review. Treatment, Payment, Health Care Operations: You should be aware that during the course of our relationship, we could use and disclose heath information about you for treatment, payment, and healthcare operations. Examples of these activities are as follows: Treatments: We may use or disclose your health information to other health care providers providing treatment to you. Payment: We may use and disclose your health information to obtain payment for services we provide to you. Health care operations: We may use and disclose your health information in connection with our health care operations. Health care operations include clinical education, quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and employee performance and other business operations. Contacting You: We may contact you by phone, text, email, or postal service for health related matters and thank you notices. Messages may be left on an answering machine, voice mail, or with a person answering your specific phone number(s). Authorization: You may specifically authorize us to use your health information for any purpose or to disclose your health information to anyone by submitting such an authorization in writing. Upon receiving an authorization in writing from you, we may use or disclose your health information in accordance with that authorization. You may revoke an authorization at any time by notifying us in writing. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those permitted by this Notice or Law.