Dr. Trevor Clark, DC
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Insurance & forms

Insurance Coverage
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We accept insurance at East County Chiropractic, however not all insurance plans cover chiropractic care. In the case that your plan does not, please remember that you will be responsible for payment in full. By contacting your insurance company you will be able to find out the scope of coverage.  If you prefer, Dr. Clark would be happy to inquire about your plan coverage on your behalf.  Simply contact us with your insurance card information at the time you schedule your appointment.

We also accept auto accident, workers compensation and personal injury cases.  If you will be receiving coverage under one of these categories, we ask that you bring this to our attention when you schedule your appointment.

Patient Forms
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Thank you for taking time to complete the following forms prior to your first appointment.  Please review all of the documents, however you will only need to print, complete and submit the following forms:
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  • New Patient Registration
  • Financial Policy
  • Informed Consent
  • Receipt of Notice of Privacy
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​If you are unable to fill out the forms beforehand, please be sure to arrive 10 minutes earlier than your scheduled check-in to allow time for completion.  Dr. Clark thanks you in advance for your assistance!
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​New Patient Registration

new_patient_registration.pdf
File Size: 145 kb
File Type: pdf
Download File

Notice of Privacy Practices

notice_of_privacy_practices.pdf
File Size: 254 kb
File Type: pdf
Download File

Receipt of Notice of Privacy 

receipt_of_notice_of_privacy.pdf
File Size: 87 kb
File Type: pdf
Download File

Financial Policy

Informed Consent

Patient Rights & Responsibilities

financial_policy.pdf
File Size: 123 kb
File Type: pdf
Download File

informed_consent.pdf
File Size: 129 kb
File Type: pdf
Download File

patient_rights_and_responsibilities.pdf
File Size: 73 kb
File Type: pdf
Download File

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  • Home
  • About
  • Services
  • CONTACT US
  • Insurance & Forms
  • Customer Praise