Insurance Verification
Dr. Cruz does not accept Healthfirst/Medicaid plans, but does work with most PPO Insurance plans and accepts HSA & FSA cards as payment

Please complete the following form prior to your visit in order to determine coverage & cost of care.

Generally, you will hear back within 24-48 hours.

I look forward to helping you with all of your chiropractic needs! If there are any questions, please don't hesitate to contact the office:

info@cruzchirowellness.com

Cruz Chiropractic & Wellness
cruzchirowellness.com 
928 Broadway, Suite 705
New York, NY 10010



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Email *
Phone number *
Full Legal Name (First & Last) *
Date of birth *
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Name of Insurance Provider (Aetna, UHC, BCBS, etc. If multiple, list primary first) *
Member ID Number *
Group Number *
Provider Phone Number ( Usually an 800 number on the back of your insurance card) *
How did you hear about us? (Instagram, referral, website, etc) If referral, please write the name of the person who referred us. *
A copy of your responses will be emailed to the address you provided.
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