Anthony Wayne Community Chiropractic
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Insurance & Forms

Most major insurances accepted.

We are in-network for the following insurance companies for chiropractic care:​
​
  • Paramount, Promedica
  • United Healthcare - Optum Health
  • Front Path Health Coalition​
  • Medicare​
  • Aetna​
We also accept most major credit cards.

New Patient Forms

To speed up your visit, feel free to print out these forms at home, fill them out and bring them with you.
New Patient Form
File Size: 54 kb
File Type: pdf
Download File

Family History Form
File Size: 765 kb
File Type: pdf
Download File

Terms of Acceptance
File Size: 1278 kb
File Type: pdf
Download File

HIPAA Policy Acknowledgement
File Size: 295 kb
File Type: pdf
Download File

health_care_authorization_form_media_authorization-2023.pdf
File Size: 63 kb
File Type: pdf
Download File

United Healthcare Chiropractor Ohio
Medicare chiropractor Toledo
Front Path Chiropractor Toledo
Promedica Chiropractor
Aetna Chiropractor Toledo
Home
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Contact

419-419-3800
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Anthony Wayne Community Chiropractic
10345 Waterville St.
Whitehouse, Ohio 43571

​All Rights Reserved, 2017-2025
  • About
    • Insurance and Forms
    • News
    • Health Resources
  • Dr. Hollerbach
    • Our Team
  • Blog
  • Hours
  • Contact