Patient Information

Hospital Affiliations

Your First Appointment

Please arrive early so we can complete your initial paperwork. Also, please bring the following:

  • Patient's insurance card
  • List of current prescriptions and/or over-the-counter medication, including dose and frequency
  • Information about patient's medical and surgical history
  • Recent test results, x-rays, or relevant records
  • Completed patient forms
  • Name and address of pharmacy

Office Visits and Cancellations

All office visits are to be scheduled. Please call our office before coming in. If you believe you have an urgent situation, please call us first before coming in. If you are more than 15 minutes late, you may be asked to reschedule.

To provide the highest level of care to all our patients, we require 24 hours notice to cancel appointments. There will be a $50 fee for the second missed or late cancelled appointment without 24 hour notification, which will be due and payable from you, not your insurance company. There will be a $150.00 charge for a missed procedure appointment. The practice reserves the right to dismiss patients with three missed or cancelled appointments.

Patient Forms

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Insurance and Payment Information

Co-pays are required for service at all times. We accept cash, personal checks, Visa, MasterCard, American Express, and Discover. We reserve the right to refuse payment in the form of a check if there are checks returned on your account. In the event that we must re-bill you, there could be a re-billing charge.

As a service to you, we will accept "assignment of benefits" and will bill your insurance carrier, provided proper paperwork is provided to us. Every effort will be made to closely estimate your co-payments and deductibles due at the time of service. However, the ultimate responsibility for the unpaid balance rests with you. Please understand that insurance is a contract between you and your insurance carrier. If an insurance carrier has not paid within 60 days of billing, any unpaid fees are due and payable in full from you.

Any charges not paid by your insurance carrier will require payment in full at the time services are provided or upon notice of insurance claim denial. Financial policies and extended payments may be discussed with our office manager. The billing policy can only be overridden with the Doctor's approval.

Privacy Practices

Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. It is given to all new patients, and a copy is available upon request.