New Patients

Welcome To Our Family

We Welcome New Patients to our QOMC Family

We are happy to have you as a new patient. Thank you for choosing Quince Orchard Medical Center as the provider for your chiropractic and rehabilitation needs.

What to Expect During Your First Visit:

To ensure that your first visit to our office is a pleasant experience, we would like provide you with the following important information:

• We ask that patients arrive as scheduled for their appointments to ensure that there is a sufficient amount of time available for evaluation and treatment.

• Please arrive 15 minutes prior to your scheduled appointment time if you are a patient utilizing your own health insurance for payment of services.

• Please arrive 30 minutes prior to your scheduled appointment time if you are going to be treated for an injury sustained by an automobile accident or for a worker’s compensation injury.

• Upon arrival you will be asked to sign in and present one of our front desk team members with:

o Your health insurance card
o Your driver’s license
o Any referrals or prescriptions given to you by your referring physician
o A written list of any prescription medications you are currently taking
o Your preferred pharmacy information- this includes the name of the pharmacy, location, and phone number

• We encourage patients to dress in loose-fitting, comfortable clothing in order to effectively evaluate and treat the involved area.

• It is our office policy that cell phones and pagers be turned off or silenced upon arrival to the office to avoid unwanted distractions or disturbances in both the reception and treatment

• Due to the repetitive nature of treatment, appointments cannot be confirmed on a regular basis, so please be sure your appointments are recorded accurately in your electronic devices or on your calendar to avoid scheduling conflicts. Our front desk team members will be happy to provide you with a copy of your scheduled appointments upon request.

Please let us know if there is anything we can do to help make your experience with Quince Orchard Medical Center one which you would happily share with your friends and family.

New Patient Forms:

Patient Information Form

Consent to Treatment

Consent to Treat a Minor

QOMC Financial Policy

QOMC Notice of Privacy Practices

Additional forms for a Personal Injury Case:

Automobile Accident Questionnaire

Assignment and Instruction for Direct Payment

Attorney Authorization and Assignment

Additional forms for a Worker’s Compensation Case:

Worker’s Compensation Accident Questionnaire

Assignment and Instruction for Direct Payment