KP Chiropractic and Acupuncture

Current Patient Information

• Forms    • Billing Questions    • Medicare     • Links

        Below is a list of forms.  If you were in an accident (Auto or Workman's comp) you must fill out a new form.  Please click on the appropriate form, print the form out, and bring the form with you to your next appointment.

• Accident Form

• Workman's Comp Form

• Consent to Treatment for Minor

       Any questions on a bill that you have received, insurance questions, or payment plan options, please call:

Julie at (309) 690-3322

or

E - mail:    

        If you have Medicare, we will send charges directly to Medicare for you.  In order to make the best possible choices for your treatment, Doctor Keller and Doctor Pepperell do not accept Medicare assignment.  This means that you are responsible for the fee of the office visit at the time of service and you will be reimbursed all of your money except for your co-pay.  If you have supplementary insurance, it may pick up your remaining co-pay. We will be happy to file a claim with your supplementary insurance for you; we need a copy of the Medicare Explanation of Benefits in order to do so.  If you have any questions, please contact Julie.

                Acupuncture Today                      Alternative Medicine Information

                Chiropractic Web                         American Chiropractic Association

                Logan College of Chiropractic          Palmer College of Chiropractic               

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