NEEL RAYA MD INC.

1203 Rivervalley Blvd, Suite-A, Lancaster, OH 43130

Phone (740) 654-6596, FAX (740) 653-2791

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NEW PATIENTS

We request the following from new patients

         Fill & sign NEW PATIENT PAPERWORK (click here to download) Patient information, Authorizations, HIPAA, Old record release request, patient history form Arrive 30 minutes before scheduled appointment time.

         Bring your insurance card - We will call your insurance company to verify coverage & deductibles - any deductibles will need to be paid prior to being seen - if payment not made we reserve the right to cancel/reschedule the appointment.

 

         We reserve the right to charge $175 at visit to the NEW PATIENT while waiting for the insurance to pay, this will be applied as a credit after payment is received from the insurance company and refund of credit can be issued.

 

         Copays & Deductibles are due prior to the visit; we will not bill you for this. We accept cash, checks; Credit cards involve a transaction fee.

 

         HSA (Health Savings Accounts), Insurance cards with VISA logo will be considered as self-pay and we will charge them at appointment, we will also submit the charge to your Health Insurance company and after we receive the EOB the account will be appropriately charged/credited.

 

         Bring any previous medical records if available.

 

         Bring ALL your medication BOTTLES (just a LIST is not enough).