Intake Form Troubleshooting Q&A

GENERAL

Do I have to fill out this form?


Yes. Every new patient is required to fill out and submit our New Patient Intake Form within 1 HOUR of scheduling their first appointment. Your appointment is not confirmed until the Intake Form is received back in our office. If your Intake Form submission is not received 1 HOUR after you scheudle an appointment, your appointment will be rescheduled to a later date.




What happens if I don't fill out the form 48 hours before my scheduled appointment time?


Your appointment is NOT confirmed until the required Intake Form is received back in our office. If your Intake Form submission is not received 48 hours prior to your appointment time, your appointment will be rescheduled to a later date.




Can I show up early and fill out the form in your waiting room?


No. Due to COVID-19 Safety Protocols, we cannot allow new patients to arrive early and sit in our waiting room while filling out the New Patient Intake Form. Please plan ahead and complete the form before your scheduled appointment time. Thank you for understanding and cooperation.




Do I have to fill out the entire form?


All questions marked with a red asterisk (*) are required and must be filled in before the form will allow you to move on the the next page or submit. If the question does not apply to you, please write in N/A or not applicable. If you don't know the information the required question is asking for, please write in unknown.




Why is the form asking for my credit card information?


For new patients scheduling their first visit, a credit card is required to confirm an appointment. Your credit card will NOT be charged unless you violate our No Show Policy. Your credit card account will show a "pending" transaction and the funds will be reserved (subtracted from your total funds amount). This authorization will be cancelled upon your appointment arrival or phone call notification to reschedule or cancel your appointment. If you are not able to make it to your appointment, please call the office 24 HOURS IN ADVANCE to notify us and reschedule. Dallas Chiropractic Metrics will charge a fee of $45.00 for any no-call, no-show patients. Thank you for your cooperation and understanding.




Why was my credit card charged?


When you fill out the Intake Form, your credit card will be pre-authorized and NOT charged unless you violate our No Show Policy. Your credit card account will show a $45.00 "pending" transaction and the funds will be reserved (subtracted from your total funds amount). This pre-authorization will be cancelled upon your appointment arrival or phone call notification to reschedule or cancel your appointment. If you are not able to make it to your appointment, please call the office 24 HOURS IN ADVANCE to notify us and reschedule. Dallas Chiropractic Metrics will charge a fee of $45.00 for any no-call, no-show patients. Thank you for your cooperation and understanding. If your credit card account shows a $45.00 posted transaction fee (not pending), then you violated our No Show Policy and did not attempt to notify our office via phone or email that you would not be able to make your scheduled appointment time. If you believe you were charged in error, please call our office at (214) 272-9509 or email DrTina@DallasChiropracticMetrics.com.





PROBLEMS

I can't find the answer to my question. What do I do now?


If you still have questions after reviewing the Troubleshooting Q&A section, please call our office at (214) 272-9509 or email DrTina@DallasChiropracticMetrics.com.




I clicked the Submit button but how do I know if you received it?


After you click the submit button, the Thank You page (see image below) will display letting you know your submission was received. If you do not see the Thank You page after waiting at least 15 seconds after clicking the submit button, then it is highly unlikley that we received your form submission. Please wait at least 15 minutes (due to privacy settings and form data encrytion, submissions sometimes take several minutes to appear in our system) and then call our office at (214) 272-9509 or email DrTina@DallasChiropracticMetrics.com to inquire after the status of your form submission.




I'm clicking the "Next" button but can't move on to the next page.


If a question is marked with a red asterisk (*) then it is required and must have an answer filled in before the form will allow you to move on to the next page. The questions left blank will highlight in red and a red bar at the top of the form page will inform you that there are errors that must be corrected before you can move forward (see example image below). If the question does not apply to you, write in N/A or not applicable. If you don't know the information the required question is asking for, please write in unknown.




How do I know if there is an error on my form submission?


When there is an error on your form submission (i.e. a required field is blank, phone # or date of birth formating is incorrect), the erroneous questions will highlight in red and a red banner will appear at the top of the form page to notify you that there are errors on your form submisison (see example image below). All errors must be fixed before the form will allow you to move to the next page of submit. If a required question does no apply to you, write N/A. If you do not know the answer to a required question, write Unknown or select the best possible answer.





GROUPON

I have a Groupon. Do I need to fill in all the health insurance information?


No. If you purchased one of our Groupon Deals, you can either skip the health insurance questions or type GROUPON in the answer fields.