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FORMS/POLICIES

What to Bring to Your Appointment:

  • Photo ID

  • Insurance Card

  • A current list of medications

  • Payment for your copay, co-insurance, deductibles, etc.

  • Pertinent medical records

 

Our Patient Scheduling Policy: 

We are committed to providing our patients with the best possible medical care while also minimizing administrative costs.  This scheduling policy has been established with these objectives in mind to avoid any misunderstanding or disagreement concerning payment for professional services.

New Patients:

Due to an increased number of no shows and cancellations of new patient appointments, we are now charging a $25.00 fee for all appointments that have not been cancelled 24 hours prior to the scheduled appointment date.  A payment of $25.00 will be required to schedule and secure ALL new patient appointments.  This payment will be taken over the phone when scheduling the appointment and can be applied to your account for usage of a co-payment upon checkout.


Any new patient that no shows their first appointment will not be rescheduled with either provider.


If you are unable to keep your appointment, kindly call our office at least 24 hours prior to your appointment time.  We will work with you to reschedule you to a more convenient time.  The $25.00 fee will be applied and charged to all appointments cancelled and NOT rescheduled 24 hours prior to the appointment date.  If you fail to cancel your appointment within 24 hours, your $25.00 deposit will be forfeited.

Cash payments and co-payments must be paid at the time of service.  If requested, the $25.00 deposit can be applied to your account for usage of a co-payment upon checkout.


We do NOT accept Medicaid as a secondary insurance.  If Medicaid is secondary, you will be required to sign an agreement understanding that Medicaid will not be accepted.


Our office does not accept non-established self-pay patients.


A physician will review the medical records of all Medicaid and self-referral patients before being scheduled.

Follow-up Appointments:

Established self-pay patients are required to bring $100.00 to each visit and will be collected prior to being seen by the physician.  Any remaining balance will be billed to the patient’s address on file. 


Established patients with a balance greater than $100.00 must clear the outstanding balance with the billing department before scheduling any future appointments.  Payment plans can be arranged if necessary. 

Any patient who cancels three (3) appointments without giving 24 hours of notice will be discharged from the practice.

Any patient who no-shows two (2) appointments in a calendar year will be discharged from the practice.  It is the patient’s responsibility to keep up with their appointment times.  We send automated calls as a courtesy.

It is the patient’s responsibility to obtain any insurance referrals required for their office visit.

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Our practice firmly believes that a good physician-patient relationship is based upon understanding and good communications.  Questions about financial arrangements should be directed to the medical practice.  We are here to help you.  

Doctor and Patient

Payment Accepted

Cash, check, Mastercard, Visa, and American Express

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