patient forms Eugene, OR
At Benessere Chiropractic, we offer patient forms online so you can complete them in the convenience of your own home or office. Fax us your printed and completed forms or you may bring them during your visit.

Standard Registration Forms

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Auto Registration Forms

Oregon personal injury law allows Chiropractors to be primary care physicians for motor vehicle related injuries, regardless of who is at fault.  The injured person may be the driver, passenger, pedestrian or bicyclist hit by a motor vehicle.  The care period is referred to as the personal protection period or PIP.  The PIP covers “reasonable and necessary” treatment for 24 months following the date of injury.  Coverage for treatment is limited by the amount of PIP coverage defined in the insurance policy.  This PIP amount is set at the time the policy is drafted and has a variable limit at the discretion of the policyholder.  Increasing the PIP coverage usually reflects as a very small increase in the monthly premium and maximizes the benefits to those who were injured. If you have any questions or concerns regarding coverage for such a plan, please feel free to contact our billing specialist here at Benessere.

Medicare Registration Forms

Workers Comp Registration Forms

Oregon workers compensation law allows Chiropractors to be primary care physicians for work related injuries.  Chiropractors are able to treat injured workers for 18 visits or 60 days, whichever comes first.  During that time a Chiropractor may coordinate care by referring injured workers to other health professionals and imaging facilities for diagnostic testing.  During Chiropractic care, the Chiropractor is designated as the Primary Treating Physician.  Patients may also see a Medical Doctor while receiving Chiropractic care.

Icing Guidelines

Click here to download icing instructions or refer to guidelines below:

Instructions

  1. Always use a gel pack; if not available,
    a bag of frozen peas can be substituted for a gel pack.

  2. Place a thin layer of cloth between skin and ice to prevent frostbite, which could appear as a grayish color of skin.

  3. Ice for 15-20 minutes only.

  4. Before icing again, wait 20 min. until skin is warm again.

  5. If icing increases pain or muscle tension, apply heat  afterward.

  6. Alternate heat with ice – 10 min. heat, 10 min. ice.

  7. When alternating, begin with heat & end with ice.

FOUR Stages of Sensation:

Cold, Burning, Aching, Numb “CBAN”

Physiological effect of icing:

Icing creates a local constriction of blood vessels which moves blood away from the area; when the ice is removed, the blood vessels open to supply nutrition and oxygen to the tissues.  Ice also numbs the area and reduces pain signals to the brain.

ANTI-INFLAMMATORY FOODS

  • Fruits

  • Vegetables

  • Nuts

  • Potatoes

  • Fresh Wild Fish

  • Wild Game

  • Grass/pasture-fed meat

  • Omega-3 eggs

  • Organic butter

  • Organic coconut oil

  • Organic extra virgin olive oil

  • Dark Chocolate (>70% cacao)

  • Stout beer    

  • Red wine       

  • Balsamic vinegar 

Spices:

ginger, turmeric, garlic, oregano, marjoram, cumin, etc.

Grains:

brown rice, quinoa, & millet. (less hybridized)

PRO-INFLAMMATORY FOODS

  • Refined grains

  • Whole grains: Wheat, oats, corn (more hybridized)

  • Grain/flour products

  • Grain-fed meats/eggs

  • Most packaged foods

  • Most processed foods

  • Corn, safflower, sunflower, soybean oil

  • Most salad dressings

  • Trans fats (margarine, and in most packaged/processed foods)