For shorter wait times, please
complete and bring the following forms to your first appointment.
Mark N/A or None when a section does not apply to you.
Adult History
Form
Child History
Form
Financial
Policy
Patient
Information Form
Patient
Privacy Practices
Patient
Consent Form
These forms are in Adobe PDF format.
*Please bring your insurance card(s),
valid drivers’ license or photo ID, and your insurance
policyholder information; this is the person who holds the policy
under which you are covered.
The required information is the holder's name, social security number, date of
birth and name of their employer. If
this information is missing it may be necessary to reschedule your
appointment until it is available to you.
*Please
be aware of your insurance co-pay, deductible and coinsurance. All
co- pays, deductibles and coinsurance are collected at the time of
your visit with no exceptions.
Specialist co-pays may not cover all diagnostic services performed
in the office. Please contact your insurance carrier to determine
individual benefits.
*Obtain
an authorization or referral if required by your
insurance. Please contact your insurance company or
primary care physician for more information.
*Bring any pertinent
medical records pertaining to your visit such as scans or test
results. This is helpful to diagnose and treat your condition. |