To help streamline your first visit, we have listed the paperwork needed below as a new patient. Simply click the download button below, print out the forms, and bring the completed forms to your first visit. Thank you for choosing Gose Chiropractic and we look forward to addressing your health needs.
Anthem
Anthem Blue Cross Blue Shield
Medben
Medical Mutual of Ohio
Medicare
Medicare Advantage (UHC/Cigna/Anthem/MMOH/CVS)
Ohio Healthy
Ohio Health Choice/Plus
Ohio PPO Connect
Trustmark - The Ohio State University Systems
United Mine Workers of America (UMWA)
UMR - Athens County Schools Consortium/Hopewell Health
Veterans Affairs Community Care Provider
*We do not accept any Ohio Medicaid plans such as: Buckeye Health, CareSource,
Molina, Humana Healthy , Paramount Advantage, or UHC Community Plan.
*We are not providers for Cigna or Aetna
Please call if you are unsure if we are in your current insurance plan.
Gose Chiropractic
22 South Plains Road, The Plains, Ohio 45780, United States
P: (740) 797-4949 F: (740) 797-1889
Copyright © 2023 Gose Chiropractic - Jonathan Gose DC DACBSP, DACRB, ICCSP, CERT DN
All Rights Reserved.