Health and Therapy Forms and Fees

---

We value our patients. We also realize that visiting a provider for the first time can be a bit intimidation.  We want to do everything we can to eliminate any unnecessary stressors, which is why we include the option of printing and completing your minimal paperwork at home.  We value your time and will not keep your waiting once you arrive for your appointment.  You may make an appointment online or by calling us. We are excited to meet you and help you with your needs!  Remember, have been located in Altamonte Springs for over 35 years.

If you have any health and medical or other questions regarding your first visit, please don’t hesitate to call us at (407) 660-1200.

Forms

New Patients

•     New Patient Questionnaire (Case History)
•     Consent To Treat Form
•     HIPAA Disclosure
•     Office Policy

Auto Accident Patients

•     New Patient Questionnaire (Case History)
•     Consent To Treat Form
•     HIPAA Disclosure
•     Standard Disclosure
•     PIP, No-Fault Application (Auto Accident Form)

Documents

•     Dr. Bennett’s Professional License
•     County Business License
•     License Look-Up

Fee Schedule

•     New Patient Exam – $50

                    Minimal symptoms requiring no more than 10-15 minutes to evaluate.

•     New Patient Exam – $70

                    Moderate symptoms requiring no more than 30-minutes to evaluate.

•     Spinal Manipulation – $50

                    Adjustment to 1-3 regions of the spine, following reassessment.

•     Physical Therapy Modalities (Fees range from $10-$30 each)

                    1 unit of EMS, ultrasound, traction, Ice/heat, rehab or other

•     Cryoderm Topical Analgesic – $15

                    Topical pain reliever in gel, roll-on or spray bottle.

•    Standard Process nutritional products

                    High Quality, Whole food-based nutritional Supplements.