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 $150 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
Bring any previous
medical records if available.
Bring ALL your
medication BOTTLES (just a LIST is not enough).