New Patient Form / Accident Form

(Download these forms (right) by clicking on the icons)

(Both the New Patient Form and the Accident Form are

PDF fillable forms which can be filled out from your computer keyboard and then saved for transmission to us.

If you choose to submit them in person at the time of your visit, they are 8 1/2 x 11 for ease in printing from your home printer.

Please complete the forms prior to your office appointment for a new patient consulation with Dr. Pelton.  


Neck Disability Form / Low Back Disability Form

(Download these forms (right) by clicking on the second 2 icons)

Submit the completed forms at the time of your visit.

They are 8 1/2 x 11 for ease in printing from your home printer.

Please complete the forms prior to your office appointment for a new patient consulation with Dr. Pelton.  


HIPAA Privacy Rule Form

(Download the HIPAA Privacy — click on icon (right)

In 1996, the Health Insurance Portability and Accountability Act or the HIPAA was endorsed by the U.S. Congress.  The HIPAA Privacy Rule, also called the Standards for Privacy of Individually Identifiable Health Information, provided the first nationally-recognizable regulations for the use and/or disclosure of an individual's health information.

Essentially, the Privacy Rule defines how covered entities use individually-identifiable health information or the PHI (Personal Health Information).

The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety. 


Effects of Spinal Misalignments Chart

(Download the illustrative spinal chart — click on  bottom icon

The nervous system controls and coordinates all organs and structures of the human body.  Misalignment of spinal vertebrae and discs may cause irritation to the nervous system and affect the structures, organs, and functions that may result in the conditions shown in this chart.


Patient Center

Bluegrass Chiropractic offers several payment options

and we file all insurance claims for you.

Insurance Accepted

We accept most insurance plans, inlcuding medicare and medicade, and

participate in workman’s compensation, auto accident insurance, personal injury.

√  Anthem Blue Cross         √  KY HMO Acordia          √  UK HMO                        

√  Aetna                               √  UHC and CHA                √  Workers Comp

√  Auto Insurance                √  Medicare                         √  Medicaid

No Insurance?

We offer Affordable Care amd Flexible Financing for patients who have little or no chiropractic insurance coverage.  Please ask us about your payment options when you call for an appointment.  New patients are seen immediately.

We Cater to the Whole Family

Men, women, adults, teens, children, and seniors will find great care and good health at Bluegrass Chiropractic.

Postal Workers

Back and neck pain is a fact of life for mail carriers.  Dr. Pelton knows too well what carrying mail can do to a mail carrier’s spine becasue his father was

a mail carrier for many years.  Dr Pelton offers a special new-patient discount to postal workers.



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