Kingston West Family Chiropractic
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New Patients and Clients

We kindly ask to bring the completed forms with you to your initial visit and arrive about 5 minutes early. The forms can be found under the forms section of our website. If you need to complete your paperwork in the clinic, please let us know in advance of your appointment and please arrive 15 minutes early to give yourself ample time to complete the forms prior to the start of your appointment. 
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Please not we have a 24 hour cancellation policy.  We value your time and we appreciate when you value ours as well as the time of other members of our practice. For this reason we do have a 24 hour policy for changing or cancelling appointments. Appointments cancelled with less than 24 hours notice will be charged the fee equivalent to the missed or cancelled appointment.

If you have a dental plan, there is a good possibility that you have coverage for most of the services offered at KWFC. Please check your individual policy for more information. 

All policies differ in coverage amounts and certain policies require a medical doctor or nurse practitioner prescription prior to your massage therapy or kinesiology treatment to be eligible to claim the amount back through your policy.

Your insurance provider may request a deductible to be paid to them prior to treatment. All plans vary in coverage for example, if 80% of your chiropractic treatment is covered by your Insurance Provider, then you will be required to pay 20%. Please be aware of your personal insurance plan and its requirements as they may change.

We bill Blue Cross for Veterans Affairs members and Canadian Forces with approved treatment, WSIB and your auto insurer directly for treatment related to automobile accident claims.  As a courtesy we will also direct bill your insurance company should you have difficulty with the submission if the insurer is affiliated with Telus Health eClaims.  We will also direct bill to Sun Life and Blue Cross, should you have difficulty with your claim submission. 

Payment for services is expected at the time of each visit and receipts/statements will be issued upon request. 

Many extended health care insurance companies are now allowing you to register for online claim submissions. Your reimbursement for services may only be a click away, and many provide you reimbursement by direct deposit in a matter of days.

For your convenience, we have provided links to common insurance companies registration for online claims submission. We have also provided some other common insurance company standard paper claim forms in the form section. You can print the appropriate form, fill it out and submit it to your provider for the appropriate refund.

Sunlife     
Chamber of Commerce   
Maximum Benefits 

Manulife 
Canada Life 
Belairdirect 
Blue Cross 
Greenshield
Desjardin Insurance
OTIP

For your convenience our clinic accepts
  • Cash
  • VISA
  • MasterCard
  • Interac

We have attached separate forms and information in the forms section to read through and complete where necessary, if your accident is WSIB related or due to a motor vehicle accident prior to your first appointment.

We may require additional information and may contact you by phone or email prior to your initial visit.  

Important Coverage Information
  • We direct bill to your auto insurance plan. We are registered FSRA service provides, and this enables us to direct bill you auto insurance plan for motor vehicle accident approved treatment.
  • If you do not have any extended health care (EHC) benefits which cover your treatment, and your treatment plan is approved, we will directly bill the auto accident insurance company on your behalf.
  • In Ontario, if you have EHC benefits that cover some or all of your treatment related to your motor vehicle accident claim, the auto insurance company requires that your claim be billed through your EHC plan first. you would pay the clinic directly for services, and submit for reimbursement to your EHC provider, until your EHC benefits have been used up to the fiscal or calendar year. Please bring us in a copy of your EHC benefits statement showing that you have maximized your benefits for the calendar or fiscal year, as we need to send a copy to the auto insurance company.
  • Any remaining balances for service are submitted to your auto insurer and will be direct billed on our behalf.
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  • We bill directly to WSIB for you.
  • WSIB provides coverage for chiropractic, registered massage therapy and registered kinesiology for workers injured on the job.
  • Once all of the forms have been submitted to WSIB by both the injured worker and the health care professional, there is often a period of waiting for the claim to be approved by WSIB.
  • Your options for treatment during this time, can be to wait to start treatment until the claim has been approved. As this will delay your recovery, we often recommend that you pay for your treatment yourself and start care right away. Once the claim has been approved, we will refund you your out of pocket expense and bill WSIB directly for treatment, reports and form completion as required. (Please note, you cannot submit the out of pocket expenses to your EHC provider unless your WSIB claim is denied as it would constitute double billing.)
  • Please complete the WSIB forms, found in the forms sections and bring the information to your first appointment. If you don’t have a printer, please review the required information and bring the information with you in order to complete the forms at KWFC.
  • If WSIB give you any forms for us to complete on your behalf, such as a FAF (functional abilities form) please bring the paperwork to KWFC. This information is only sent to you, as the injured worker, claimant, not to the clinic, as we are considered a third party. Your co-operation is appreciated. 

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613.389.5331
KWFC
  • Home
  • About Us
    • Our Team >
      • Doctor
    • How We Can Help
    • Clinic Tour
    • Policies
    • Links and Research
    • Products
  • Services
    • Chiropractic >
      • Prenatal Chiropractic Care
    • Registered Massage Therapy
    • Acupuncture
    • Custom Foot Orthotics
    • Concussion Management
    • Laser Therapy
    • Rehabilitation >
      • Other Services
    • Registered Kinesiology
    • Compression Socks
  • New Patients and Clients
    • What to Expect >
      • Chiropractic appointment
    • Fees
    • Forms
  • Contact Us