We ask that you come to our office 20-30 minutes before your scheduled appointment time to fill out paperwork. Or, if you prefer, you may print out the forms and fill them out ahead of time.
On an initial naturopathic medicine visit:
- Dr. Peters will conduct a thorough health history, including diet and lifestyle factors.
- Physical exam will be performed according to indications. If any lab work is necessary, we will go over that during your visit. (If a fasting blood sample is needed, we can schedule a separate visit for that.)
- You will be given any necessary immediate care and home instructions.
- We may ask you to authorize a release of records from other facilities where you have received treatment.
- In many cases, we ask that you return once all lab results and outside records are received for your report of findings. This gives the doctor a chance to tailor a treatment plan to your individual needs.
- Your first visit will last 60-90 minutes.
On an initial chiropractic visit (back/neck/joint pain, headaches):
- Dr. Peters will conduct a thorough health history.
- Orthopedic/neurologic exam will be performed according to indications. If any imaging (X-rays, MRI) is necessary, Dr. Peters will refer you to an imaging facility.
- In many cases, treatment may be rendered on the first visit. Dr. Peters primarily uses a low-force technique called Neurostructural Integration Technique (NST) — see our FAQ for more details.
- Your first visit will last about 60 minutes.
- We are happy to verify insurance benefits for you and bill medical, auto, or workers’ compensation insurance. We are preferred providers for Blue Cross/Blue Shield of Illinois, Coventry, and MultiPlan. We are also providers for Medicare (coverage limited to chiropractic spinal adjustments only). Other insurance is accepted at out-of-network rates.
- Unfortunately, Medicaid (Illinois Public Aid) does not cover any services at CINHC.
- Payment for deductible, copayments, and products is expected at time of service. We accept cash, check, Visa, MasterCard, American Express, and Discover.
- We are participating providers in ChiroHealthUSA, a discount medical plan organization. If you are uninsured or only have partial coverage, please contact us for further information about this money-saving program.
If you are a new patient, you may print out these forms and fill them out ahead of time. Please bring them with you to your first visit. To protect your privacy, these forms cannot be completed online–we apologize for the inconvenience.
Please note: These forms require the free Adobe Reader. Download the latest version by clicking the image below:
Tip: You may either left-click to open these documents within your browser window, or you may right-click and choose “Save Target As…” or “Save Link Target As…” to save the files to your computer. Remember where you save them. Then locate the files, and open them by double-clicking.
- Please print and complete the registration forms for the appropriate age category:
- Is low back pain the main reason for your visit? Please print and fill out the following form:
- Is neck pain the main reason for your visit? Please print and fill out the following form:
- Medicare patients, please print and sign the following disclosure:
If you are coming in for a scheduled gynecological examination, please print and complete the following form:
If you are an adult male coming in for a physical exam (no current medical complaints), please print and complete the following form: