New Patient Forms

New Patients Forms 

About Your Coverage 

By Kathleen Frederickson

I am the Insurance Coordinator for Dr. David C. Kolbaba and Associates.

We want to assist you in understanding your health care benefits and the services we provide through our clinic.

Scroll down the page to view and download our “New and Current Patient” Forms.

Insurance submittance and explanation of benefits are provided for your convenience. Verifying and explaining your benefits is typically done on the day of your New Patient Strategy Consultation. Personally, I believe our clinic is unique in this respect because most health care offices will not take the time to review your benefits with you. We want you to have a good understanding of your coverage as it relates to the services we provide.

We offer a uniquely effective health and lifestyle educational program and want to assist you in the understanding of an area of your health that is vital to yourself and your loved ones. 


  • Board Certified Clinical Nutrition
  • Certified Addiction Counseling
  • Health Coaching
  • Conservative Chiropractic Care
  • Nutritionally Based Comprehensive Physical Exam


  • Blood
  • Stool
  • Saliva
  • Urine



  • Acupuncture
  • Transcutaneous Electrical Nerve Stimulation (TENS)
  • Auricular and Meridian Therapy
  • Ultrasound and Cold Laser Therapy

Dr. David C. Kolbaba is a participating physician with Medicare. Contact me for details about our “Family Care” packages.

If you receive your insurance benefits through your employer, they may offer a variety of plans for you to choose from. It is wise to know when your sign-up period is. These plans should be looked at carefully, to ensure coverage for our office and services. We also offer a self-pay plan for those patients without health care insurance.

Please feel free to call our Clinic and speak with me personally about your coverage concerns at 847-428-8850.

``We’re here for you!``

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