Before You Visit


Family Chiropractic Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Fax us your printed and completed form(s) or bring them with you to your appointment.

New Patient Forms:

Auto Accident Forms:

Request for Records:


Automobile Accidents or Personal Injury

Please present your auto insurance forms as soon as possible when you are involved in an auto accident. If an attorney is handling your case, please notify the insurance department right away. Although you are ultimately responsible for your bill, our office will wait for settlement to be paid as long as you are an active patient. After your care is completed, you will have six months to settle your claim. Once the claim is settled or if you suspend or terminate care, any fees for services are due immediately.accidentad2

Health Insurance and Managed Care

Please present your insurance card to the receptionist. As a courtesy to our patients, our office will complete any necessary insurance forms at no charge, and file them with your company to help you collect. Services rendered are charged to you directly and you are personally responsible.

While most policies do provide coverage for chiropractic care, we do not know the specific coverage of your policy. The amount paid varies from one policy to another. Because of this difference among policies, we will expect you to pay any deductible and any co-pay as stated in your policy. Interest at the annual rate of 18% will be charged on all patient balances left over 90 days.

When all insurance checks have been received, we will refund any overpayment to you.

"On The Job" Injury

Worker’s Compensation pays in full for chiropractic care. Once you are released from care, a 3-month time period is allowed for settlement of your claim. If settlement has not been reached within this time period, or if you have suspended or terminated your care without your doctor’s approval, payment for services is due immediately.

Patients Without Insurance

We request that 100% of the first visit be paid at the time of the first visit. For your convenience, payment may be arranged at the last visit of each week if you sign a credit guarantee form. We are happy to accept your check, MasterCard, or Visa. We also offer CareCredit, a special credit card just for healthcare. Ask us about this convenient payment option.


We accept assignment from Medicare. The check is usually sent directly to our office in payment of the services that Medicare will cover. For chiropractors, this includes only manual manipulation of the spine. Medicare pays 80% of the allowable fee once the deductible has been met and the patient will be required to pay the remaining 20%. The patient is also responsible for payment in full of all non-covered services. Subsequent services will be payable at the end of each week or from a monthly statement. Our office will complete the necessary forms and file them with the Medicare provider at no charge.


Arkansas Medicaid covers Chiropractic. Please contact the office for a free consultation and we will be glad to assist you.


Arkids covers Chiropractic. Please contact the office for a free consultation and we will be glad to assist you.


8:30am - 6:00pm

8:30am - 6:00pm

8:30am - 6:00pm


8:30am - 6:00pm


Chiropractic Fayetteville AR Family Chiropractic Center Logo

Family Chiropractic Center
114 South College Avenue Suite A
Fayetteville, AR 72701
(479) 442-0676