Patient Registration Form (required for all patients)
Please plan on arriving to your first visit at least 15 minutes before your scheduled appointment time. Please remember to bring the following items:
Some insurance companies require referrals for specialist visits. If your insurance requires a referral, please bring it with you to your appointment. It is your responsibility to provide us with a copy of your referral. If you arrive without a referral we may need to reschedule your visit.
If you are more than 15 minutes late for your appointment, you may be asked to reschedule for another day and time. If possible, we will try to work you in to the schedule but patients who arrived on time will be seen first. If we cannot accommodate you on the same day, it will be considered a no-show appointment (see no-show policy below).
We expect all patients to be present for their scheduled appointment time. If for some reason, you need to reschedule we require one full business day advance notice. If you should miss your scheduled appointment time, our staff will contact you. Please note that missed appointments or failure to provide adequate notice for appointment cancellations prevent other patients from accessing medical care. If you miss an appointment, we will assess a $50 non-refundable charge to your account and future visits may require a $50 reservation fee. This reservation fee will be applied to your co-pay, or patient account balance.
Payment is collected at the time services are rendered. Most insurance companies require patients to pay for co-pays, deductibles, and co-insurance. Please be aware that because there are so many different insurance plans, we may not know your exact benefit or co-payment. It is in your best interest to know the specifics of your insurance plan.
We accept cash, checks, Master Card, Visa, American Express and Discover. If other payment arrangements are necessary, please contact our billing department. They are willing to assist you in this matter. Please note there is a $25 returned check fee.
Prescription refills will be processed within 2 business days. Please provide us with the medication name, dose, and the telephone or fax number for the pharmacy.
All medical records requests must be made in writing with a signed medical release. Our medical records request form can be obtained here. Please fill out the patient portion of the form completely and allow 5 business days for our staff to process your request. Please note that a processing fee is required and varies depending on the number of pages copied. Our staff will give you the exact cost when you submit your request.
A fee of $5 is charged for copying your x-ray files. Please allow 24 hours for completion of your request.
A fee of $5 is charged for the completion of each disability form. This fee must be paid at the time the forms are dropped off. Please complete the patient portion of each form prior to dropping them off. We require 5 business days for the completion of your disability paper work.
Unfortunately, at this time we do not accept worker's compensation insurance and do not treat work related injuries in non professional athletes. We also do not evaluate individuals involved in motor vehicle accidents without physician approval.