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Auto Accident Form

Patient Intake Form

If You Have You Been Involved in an Automobile Accident…,

We Can Help!

At New Leaf Chiropractic Wellness Center you get the attention, care, and outcome you desire. Call us today, or schedule an appointment HERE if you have been involved in an automobile accident or other personal injury.

Personal Injury

As the survivor of a catastrophic auto accident in 1995 caused by a negligent driver, Dr. Pease is keenly aware of the immense physical, emotional, and financial toll that people and their families confront after an unexpected injury.

We provide for your personal needs from day one, ensuring that your exclusive focus is on getting you the medical care you need.

What can I expect from New Leaf Chiropractic Wellness Center for treatment of my injuries?

  • An evaluation by Dr. Pease using orthopedic exams, X-rays, or other diagnostic tests
  • Functional Evaluation Testing
  • A diagnosis of your condition
  • A customized treatment plan based upon your specific needs
  • We work with various attorneys, Auto Insurance, Med Pay insurance, and/or personal health insurance.

What types of injuries might I sustain in an automobile accident?

  • Structural or Soft-Tissue Muscle Strains and Ligament Sprains
  • Back Pain
  • Neck Pain
  • Headaches
  • Pain in the Arms, Legs, Hands, or Feet
  • Whiplash

What if my injuries require a specialist?

New Leaf Chiropractic Wellness Center will make the appropriate referral for you and co-manage your case direction with the specialist.

Who pays my health care bills in the event of an automobile accident?

Your auto insurance, medical health insurance, Med Pay insurance, and/or personal injury settlements through an attorney.

Do I need an Attorney?

Depending on the circumstances surrounding your situation an attorney may be advisable, however it is not always necessary. In the event an attorney would be advisable, referrals to qualified representation are available.

Personal Injury Law

The Florida Motor Vehicle No-Fault Law, Senate Bill 1860, was intended to reduce vehicular accident fraud. However, it also created sweeping changes in the ability of a victim to receive medical treatment for vehicular accident injuries.

Although the PIP Laws will help fight fraud, it also means that legitimate accident victims not only can anticipate up to a 75% reduction in PIP benefits, but also must follow stringent guidelines to receive medical assistance for their injuries.

Experiencing an automobile accident can be traumatic however the aftermath can be far more devastating — especially if you’re denied benefits due to the PIP Laws. This is why we recommend that anyone who is the victim of a vehicular accident follow the guidelines that the law requires, as well as seek immediate medical attention for any injuries sustained.

Changes to the PIP Laws involve:
  • Filing a crash report including information about all drivers and passengers.
  • Limiting Emergency Treatment Payouts to $10,000.

Emergency Treatment is defined as:

  • Serious jeopardy to health
  • Serious impairment of bodily functions
  • Serious dysfunction of bodily organs or parts
  • Limiting Non-emergency treatment payouts $2,500
  • Receiving medical care within 14 days after the automobile accident.
  • If no treatment is received within the 2 week timeframe, then NO personal injury benefits will be paid out. All medical conditions sustained in an accident must be verified by a physician, osteopathic physician, dentist, physician’s assistant or advanced registered nurse practitioner.
  • Acupuncture and massage therapy are no longer covered, regardless of who administers the treatment.

Did you know?

  • Studies show that a 10mph accident equals the same force on your spine as dropping a 40 lbs sack of potatoes from a 2story building onto your head.
  • The majority of primary care physicians do not provide comprehensive injury care for auto, sports, or personal injuries.
  • Your health insurance may not take care of injuries sustained in an auto or personal injury accident.
  • You do not need to have an attorney to be treated by Dr. Pease.
  • You have the right to be treated for your injuries, even if you are at fault. You are still covered.
  • It is estimated that 15-40% of those who are injured in a motor vehicle collision will suffer from ongoing chronic pain.(Journal of the American Academy of Orthopedic Surgeons, 2007)
  • Whiplash injuries not only increase the incidence of chronic neck and shoulder pain, it also significantly increases the incidence of other systemic ill health effects. In other words, whiplash injuries cause more than neck pain and headache, it hurts the health of the entire body.(Journal of Clinical Epidemiology, 2001)
  • That essentially 100% of those who are suffering from chronic pain caused by a whiplash injury will have an abnormal psychological profile with standard assessments, and the only way to resolve the abnormal psychological profile was to successfully treat the chronic spinal pain. Psychotherapy was not able to improve the abnormal psychological profile, nor was it able to improve the patient’s chronic pain complaint.(Pain, 1997)
  • In the longest study ever performed on whiplash-injured patients (a study looking at the health status 17 years after injury), 55% of the patients still suffered from pain caused by the original trauma.(Accident Analysis and Prevention, 2002)

Consequently, it is inevitable that some whiplash-injured patients will develop chronic pain and that chiropractic is often the best management choice for these patients.

If you have any questions, please contact us to discuss your unique medical situation so that we may create a treatment plan to get you back to feeling your best.


New Leaf Chiropractic Wellness Center offers our patient form(s) online so they can be completed in the convenience of your own home or office.

  • All forms are PDF files. You will need AdobeReader® to view them.
  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print them out and fill in the required information.
  • Fax us your printed and completed form(s) to (813) 567-1897 or bring them with you to your appointment.

New Patient Paperwork

Download & Print Form

Auto Injury Paperwork

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Meet Our Team

  • Dr.
    Michael J Pease D.C.
    Chiropractor
    Dr. Michael J Pease is originally from Maine and was stationed in Florida during his USAF enlistment. Prior to studying to become a Chiropractor, Dr. Pease served in the Gulf War and then later spent many years working as a technician and engineer in the telecommunications industry. Dr. Pease graduated with a Bachelor of Science Degree in Business Management from Nova Southeastern University of Fort Lauderdale in 1998.

    Read More
  • Collette
    Chiropractic Assistant
    Our friendly, professional and caring staff is here to help you through your current situation and along the journey to health and wellness.

    “As a Registered Chiropractic Assistant, I feel very fortunate to have found a career that I not only enjoy, but one that I feel so passionate about. I get the opportunity to help relieve our patients of their pain and restore their Health every day.”













Testimonials

  • "Best Auto Accident Chiropractor!"
    Anonymous

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Our Locations

Office Hours

We offer a variety of office hours in order to meet the needs of our patients.

Monday:

9:00 am-1:00 pm

3:00 pm-6:00 pm

Tuesday:

9:00 am-1:00 pm

3:00 pm-6:00 pm

Wednesday:

9:00 am-1:00 pm

3:00 pm-6:00 pm

Thursday:

9:00 am-1:00 pm

3:00 pm-6:00 pm

Friday:

9:00 am-1:00 pm

Saturday:

Closed

Sunday:

Closed