Patient Forms

 

PATIENT INFO

New Patients
We are currently accepting new patients. Please contact us to schedule a new patient consultation.

Patient Forms
Please print and fill these forms out prior to your next appointment.

Physician Forms

We participate with:
Blue Cross Blue Shield, Cigna, Wellpath, Humana, United Health Care, Aetna, MedCost, MedCost Preferred, PHCS, Medicare and Tricare Standard.

We will also file claims to other insurers, but expect payment in full at the time of service, once we receive payment from your insurer, we will refund any credit to you.Copayments and coinsurance are due at the time of service. Any balance after insurance payment will be billed to you. Please call your insurance company if you have any questions regarding your coverage and benefits using the customer service number listed on your card.

Private pay patients are, of course, also welcome. We accept Visa, Mastercard, Discover, American Express, cash, check or money order. We do not file claims to Workers Compensation or Automobile insurance claims. In these cases, you can be seen, but must pay in full and file the claims yourself.

Current Patients
Each calendar year we require our patients to fill out a new demographics form. You may fill out the form prior to your visit and bring it with you.

Medication Refills
Please be sure to refill all of your medications during your visit. If you need a refill, contact your pharmacy and ask them to send a request to our office. We ask that you allow 48 to process medication refill requests.