Patient Forms
FORMS:
Please complete the new patient forms and bring them to your appointment, along with your insurance cards and your driver’s license or a photo I.D. Per the Red Flags Compliance Act, passed by Congress to help prevent medical insurance fraud, we will be making a copy of your driver’s license or photo I.D. for your chart. Plan on arriving a few minutes early to complete the registration process.
Consent for Release of Patient Information
INSURANCE COVERAGE AND REFERRALS:
Some insurance plans will only pay for services if you go to doctors in their network or if you get a referral. It is your responsibility to call your insurance company to see if our doctors are in your network.
CO-PAYS:
It is your responsibility to know if your insurance plan requires a co-pay. If your insurance plan requires a co-pay, it must be paid at the time of your service. We accept the following forms of payment: cash, check and most major credit and debit cards.
PAYMENTS:
If you continue treatment and have an outstanding balance, we will ask you how you would like to make payment when you check in for your next appointment. We take the following forms of payment: cash, check, CareCredit, and most major credit and debit cards. All returned checks will be subject to $40.00 non-sufficient funds fee. Charges for Self-Pay patients and cosmetic procedures MUST be paid in FULL at the time of service. Payment plans for cosmetic procedures are NOT available. Any outstanding balances that are over 60 days old, will be subject to a $5.00 billing fee.
CANCELLATIONS:
We understand when your plans change and you may be unable to keep your appointment. Call and let us know or you may be charged a No Show Fee.
OFFICE TEMPERATURE:
To make our surgery patients more comfortable, our office is kept at a cool temperature and may be chilly for some patients. If you would like, please bring along a sweater or light jacket. If you have questions about any of the forms or need help with your insurance company, we will be happy to help you. We look forward to seeing you.