Notice of Informed Consent

California Code of Regulations, Title 16, Div. 4, Article 2, Section 319.1 requires your acknowledgement of proposed risks relating to care at this office in the form of an informed consent by signature on intake form.

The procedures used in this office are defined as skin surface reflexes, hard and soft tissue manipulation.  Hard tissue manipulation (chiropractic adjustments) may be incorporated infrequently in the form of spinal, cranial and or extremity manipulation.  When these manipulation procedures are employed you will be verbally notified.  As a general rule, manipulation steps are incorporated to stimulate reflexes within bony structures that act as (resetting) circuit breakers.

Soft tissue manipulation steps are a combination of rubbing, stretching, and pinching type activities.  Steps that are known to cause brief physical discomfort include stimulation of internal jaw muscles.  This step is frequently employed on every visit.  A clean finger cot is always used for this procedure.   If you have a latex sensitivity please let me know.
Office Policy
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Office Policy

Office visits are scheduled in one hour visits.  Extended visits may run 90 minutes or longer if necessary to accommodate anyone traveling a long distance.

Missed Appointments are not tolerated as I have allocated 1 hour for your visit.  

Appointment failure without a good reason: 1st offense $25 ...2nd $55 ...3rd your file will be misplaced!

In unforeseen circumstances a cancellation fee may be waived.  Last minute cancellations, please call or text Julaina's cell phone (925) 535-0800  directly instead of the office number (510.845.3246).

Cancellation policy:    Please try to call within 48 hours to best allow us to offer your visit time to someone.  If we can fill your cancellation visit time there will not be a cancellation fee.

Cancellations within 24 hours will be considered an appointment failure as listed above.
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This office will take every precaution to protect your health information and privacy however; there can be an incidental disclosure of phone messages due to an open front desk / common waiting room.   Please note my computer that maintains patient information and billing is located at my home and is of vintage type that is not connected to the Internet.

Please note that many insurance carriers request doctors files (i.e. doctors progress notes and the intake form you filled out) so include only the information you want others to peruse.
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Verbal or written permission will be sought before communicating relevant health information to other health care providers or family members.
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Billing and periodic statements will be provide:
  • As a courtesy, I will submit an itemized claim form to your insurance carrier.  
    If I have 
    incomplete information, the claim form will be mailed to you to complete and forward to your carrier.
  • All medicare billing will be completed as required by law
  • You may also request a summary statement for taxes or medical savings account at anytime.  Feel free to email me with that request.
Advanced Beneficiary Notice

Advanced Beneficiary Notice (ABN) is terminology used by Medicare to inform the public /patients of non-covered services often provided by licensed healthcare practitioners. 

 Advanced Beneficiary Notice purpose is to allow potential patients the opportunity to make informed decisions about the services of healthcare one is requesting.  Medicare has strict guidelines which restrict what type of services and diagnosis that I can make as a licensed Chiropractor.  To that extent, you are encouraged to consider (by the rules of Medicare) to consult a physician whom will provide only medicare approved procedures thus reducing ones out-of-pocket expenses to a small co-payment or a pre-approved substantially reduced medicare office visit fee.

The healthcare provided at this office are generally non-approved services, thus medicare often will reject part or all of the submitted bill.  Additionally Dr. Corwin has chosen not to be an enrolled medicare provider thus I do not except co-payments and medicare assignment.

Dr. Corwin will submit a claim to Medicare as required by law.   If you have secondary insurance, medicare will forward the claim to the secondary carrier.  

If your medicare has been assigned to an HMO (Kaiser, Health Net etc.) then none of the above is relevant and medicare can not be billed by any out of network provider.

Please note that your choice to receive care with Dr. Corwin releases your rights to appeal to medicare for fee reimbursement(s) of uncovered services, rejected billing(s) or request a reimbursement of non-covered services from the provider.  Additionally it is understood that you understand that you are responsible for all fees incurred at this office and any action to reimburse by medicare or your secondary insurance will be considered an insurance benefit and either be reimbursed directly to you or if accidentally sent to the office, a refund check will be issued for the same amount.

If you have any questions or concerns, please let me know.          Email Dr. Corwin
Office Visit Fees

* Initial Office Visit Fee:  $155 ...Consultation, Evaluation and Treatment (60 min.)

* Follow Up Visits:          $155 ...Generally scheduled weekly (60 min appointment)

* Long Term Patients may have a lower Fee Schedule .

Dr. Corwin is not an enrolled Medicare Provider.    Medicare statements will be processed as required by law.  Medicare Advanced Beneficiary Notice of Non-Coverage (ABN) is described directly above.

Payment is expected at the time of service. 

Whatever fee schedule one starts at, will remain the same throughout your active care.

Financial challenges,  speak with me during your initial visit.

having financial challenges  > bonus offer < 
Bonus Offer

If you are able make an appointment on your birthday,  the visit is free!
If your birthday does not fall on a day during my work week, better luck next year!
MISSION STATEMENT

My purpose is to address your health concerns swiftly and cost effectively.  To accomplish this, I work in 60 minute appointments.   This time frame allows me to accomplish the necessary work to minimize recidivism and maximize response to care.  My goal is to identify the causative factor(s) and return your  body, mind and spirit to optimal health.
Last minute cancellations, please call or text Julaina's cell phone (925) 535-0800 directly instead of the office number (510.845.3246).
New Patient
 Intake Registration Form
Print PDF File 
New Patient
 Intake Registration Form
Fill In PDF Form & Email as attachment to Dr. Corwin