New Patients

Be Advised: If you are coming in for an adjustment you only need to complete the first 3 forms, if you are coming in for nutrition please complete all 6 forms and bring them in to your appointment.
Click the Download for a PDF version of our New Patient History Forms
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Opens with: Adobe Acrobat
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Opens with: Adobe Acrobat
Opens with: Adobe Acrobat
Now Accepting New Patients - Canton Center Chiropractic Clinic - Dr_Potter_lecture_setupYour first visit with our office includes a thorough examination and evaluation of your current health conditions. This initial visit may take up to two hours, so we ask that you plan enough time for the complete evaluation and treatment.


We are BCBS PPO providers, Medicare and Medicare Advantage Providers, and we are in-network with Blue Care Network. BCN patients require a referral from their primary care physician to receive benefits. Please contact our office for more information on obtaining a referral. We are out-of-network for all other insurances, meaning you would be responsible for full fees at time of service. Our insurance department is happy to then submit those visits to your insurance as a courtesy to you.
If you have BLUE CARE NETWORK, make sure your referral is under Dr. Robert E. Potter, D.C. 
Your insurance benefits will be verified upon presentation of your insurance card. However, we recommend that you call to verify your Chiropractic Benefits prior to your initial visit. You are responsible for any portion of your visit not covered by your insurance, this includes co-payments, co-insurance, and deductibles.

Your Initial Appointment

On your appointment day, please bring your completed new patient form, your insurance card and Medicare card if applicable, and your personal identification (i.e.: driver’s license, state identification).
Payment is expected at time of service. We accept personal checks, cash, Visa, Master Card, and Discover along with any insurance benefits. Plan to pay any co-pays or fees not covered by your insurance company.


The most important question for our doctors to answer is whether or not you are a candidate for care in our office. Our doctors are interested in trying to completely understand your health condition. You will be asked questions related to how your condition started, what makes your symptoms better or worse, the severity of your symptoms, how long you have had them along with other related aspects of your health condition.


A physical examination will follow your consultation. This may or may not lead to services such as x-rays, or other diagnostic testing. After ruling out conditions that require an immediate medical referral, our doctors will perform an evaluation of your neuromusculoskeletal system.

Nutrition and Treatment

After your examination your visit will conclude with a spinal manipulation. Our nutritional patients should expect to receive their nutritional testing and then nutritional recommendations at this point in their visit. After your treatment, the doctor will advise a series of visits to help monitor your body as it heals. You are then on the road to wellness!
Call us today to schedule an appointment! 6231 N. Canton Center Road, Ste 109 Canton, Michigan 48187 (734) 455-6767

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Testimonials - Canton Center Chiropractic Clinic - success