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(Email address required as fulfillment packet will be sent via email.)
I hereby verify that a ChiroHealthUSA HIPAA form has been signed by the member and filed in their patient chart.
I hereby verify that member was presented HIPAA form but declined to sign.
I hereby verify that member has indicated their consent to communicate and the membership application is filed in the patient chart.
REQUIRED: Click here to read and accept "Disclosure Statement".
This discount medical plan is NOT insurance, a health insurance policy, or a qualified health plan under the Affordable Care Act. The plan only provides discounts on medical services and equipment offered by providers who have agreed to participate in the plan. The range of discounts for medical services and equipment offered under the plan will vary depending on the type of provider and medical services and equipment received. The plan does not make and is prohibited from making payments to providers for medical services or equipment received under the plan. The member is obligated to pay for all discounted medical services and equipment received under the plan, but will receive a discount on certain identified medical services and equipment from providers participating in the plan. The Discount Medical Plan Organization/Discount Plan Organization is Perfectly Protected Practice, Inc., 1307 Airport Rd. N, Suite 1A, Flowood, MS 39232, membership@ chirohealthusa.com. You may call 1-888-719-9990 for more information and to request a list of program providers and the providers’ city, state and specialty, located in your service area. You may also search for participating providers at www.perfectlyprotectedpractice.com. The plan is subject to fees, requirements, and restrictions as specified in the membership agreement and includes a 30-day cancellation provision. Note to MA consumers: The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. Not available for sale in the state of Washington.
If you cancel within the first 30 days after the effective date, you are entitled to a refund of membership fees paid. If you cancel after the first 30 days, you are eligible for a pro-rata refund of membership fees paid. If we cancel your membership for any reason, other than non-payment, you are eligible for a pro-rata refund of membership fees paid. Refunds will be issued within 30 days of cancellation. You may cancel by contacting us at 1-888-719-9990 or membership@chirohealthusa.com or Perfectly Protected Practice, Inc., 1307 Airport Rd. N, Suite 1A, Flowood, MS 39232. Members receive at least 5% off usual and customary rates. Perfectly Protected Practice, Inc. does not guarantee the quality of the medical services or equipment offered by individual providers.
This discount medical plan is NOT insurance, a health insurance policy, or a qualified health plan under the Affordable Care Act. The plan only provides discounts on medical services and equipment offered by providers who have agreed to participate in the plan. The range of discounts for medical services and equipment offered under the plan will vary depending on the type of provider and medical services and equipment received. The plan does not make and is prohibited from making payments to providers for medical services or equipment received under the plan. The member is obligated to pay for all discounted medical services and equipment received under the plan, but will receive a discount on certain identified medical services and equipment from providers participating in the plan. The plan is subject to fees, requirements, and restrictions as specified in the membership agreement and includes a 30-day cancellation provision. Note to MA consumers: The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. Not available for sale in the state of Washington.
The Discount Medical Plan Organization/Discount Plan Organization is Perfectly Protected Practice, Inc. (d/b/a ChiroHealthUSA), 1307 Airport Rd. N, Suite 1A, Flowood, MS 39232, membership@chirohealthusa.com. You may call 1-888-719-9990 for more information and to request a list of program providers and the providers’ city, state and specialty, located in your service area. You may also search for participating providers at www.perfectlyprotectedpractice.com.
If you cancel within the first 30 days after the effective date, you are entitled to a refund of membership fees paid. If you cancel after the first 30 days, you are eligible for a pro-rata refund of membership fees paid. If we cancel your membership for any reason, other than non-payment, you are eligible for a pro-rata refund of membership fees paid. Refunds will be issued within 30 days of cancellation. You may cancel by contacting us at 1-888-719- 9990 or membership@chirohealthusa.com or Perfectly Protected Practice, Inc., 1307 Airport Rd. N, Suite 1A, Flowood, MS 39232. Members receive at least 5% off usual and customary rates.
This discount medical plan is NOT insurance, a health insurance policy, or a qualified health plan under the Affordable Care Act. The plan only provides discounts on medical services and equipment offered by providers who have agreed to participate in the plan. The range of discounts for medical services and equipment offered under the plan will vary depending on the type of provider and medical services and equipment received. The plan does not make and is prohibited from making payments to providers for medical services or equipment received under the plan. The member is obligated to pay for all discounted medical services and equipment received under the plan, but will receive a discount on certain identified medical services and equipment from providers participating in the plan. The Discount Medical Plan Organization/Discount Plan Organization is Perfectly Protected Practice, Inc., 1307 Airport Rd. N, Suite 1A, Flowood, MS 39232, membership@ chirohealthusa.com. You may call 1-888-719-9990 for more information and to request a list of program providers and the providers’ city, state and specialty, located in your service area. You may also search for participating providers at www.perfectlyprotectedpractice.com. The plan is subject to fees, requirements, and restrictions as specified in the membership agreement and includes a 30-day cancellation provision. Note to MA consumers: The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. Not available for sale in the state of Washington.
If you cancel within the first 30 days after the effective date, you are entitled to a refund of membership fees paid. If you cancel after the first 30 days, you are eligible for a pro-rata refund of membership fees paid. If we cancel your membership for any reason, other than non-payment, you are eligible for a pro-rata refund of membership fees paid. Refunds will be issued within 30 days of cancellation. You may cancel by contacting us at 1-888-719-9990 or membership@chirohealthusa.com or Perfectly Protected Practice, Inc., 1307 Airport Rd. N, Suite 1A, Flowood, MS 39232. Members receive at least 5% off usual and customary rates. Perfectly Protected Practice, Inc. does not guarantee the quality of the medical services or equipment offered by individual providers.
This discount medical plan is NOT insurance, a health insurance policy, or a qualified health plan under the Affordable Care Act. The plan only provides discounts on medical services and equipment offered by providers who have agreed to participate in the plan. The range of discounts for medical services and equipment offered under the plan will vary depending on the type of provider and medical services and equipment received. The plan does not make and is prohibited from making payments to providers for medical services or equipment received under the plan. The member is obligated to pay for all discounted medical services and equipment received under the plan, but will receive a discount on certain identified medical services and equipment from providers participating in the plan. The Discount Medical Plan Organization/Discount Plan Organization is Perfectly Protected Practice, Inc., 1307 Airport Rd. N, Suite 1A, Flowood, MS 39232, membership@ chirohealthusa.com. You may call 1-888-719-9990 for more information and to request a list of program providers and the providers’ city, state and specialty, located in your service area. You may also search for participating providers at www.perfectlyprotectedpractice.com. The plan is subject to fees, requirements, and restrictions as specified in the membership agreement and includes a 30-day cancellation provision. Note to MA consumers: The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00. Not available for sale in the state of Washington.
If you cancel within the first 30 days after the effective date, you are entitled to a refund of membership fees paid. If you cancel after the first 30 days, you are eligible for a pro-rata refund of membership fees paid. If we cancel your membership for any reason, other than non-payment, you are eligible for a pro-rata refund of membership fees paid. Refunds will be issued within 30 days of cancellation. You may cancel by contacting us at 1-888-719-9990 or membership@chirohealthusa.com or Perfectly Protected Practice, Inc., 1307 Airport Rd. N, Suite 1A, Flowood, MS 39232. Members receive at least 5% off usual and customary rates. Perfectly Protected Practice, Inc. does not guarantee the quality of the medical services or equipment offered by individual providers.
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