PSYCHOLOGICAL DOCTOR'S SURVEY

Please Print, fill out and mail to:
Law Enforcement Health Benefit
1237 Spring Garden St
Phila., PA 19123

 

We are currently reviewing services rendered by many professional areas including psychologist, chiropractors, and physical and occupation therapist.  We will eventually have surveys for all medical providers.

We would request that you complete the below questions so LEHB can insure the highest quality service at a reasonable cost. 

 

Doctor’s Name:__________________________________
Company’s Name:________________________________

 

1.         Did you obtain a complete medical evaluation including x-rays, cat scans or MRI prior to seeking treatment from a chiropractor?     
Yes  No

2.         Did you obtain a medical evaluation either from your family doctor or an orthopedic specialist prior to seeking treatment from a chiropractor?    
Yes  No

3.         Do you know what your medical problem is?     
Yes  No

4.         Have you been assured in writing by your chiropractor that the services he/she is rendering will not complicate your medical condition?    
Yes  No

5.         Have you asked the chiropractor when his/her services will no longer be needed?    
Yes  No

6.         Do any other family members also see the chiropractor?     
Yes  No

7.         If LEHB did not have a chiropractic benefit and you were responsible for all cost, would you still visit the chiropractor at the same frequency you are currently going?    
Yes  No

 

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