Forms and Policies

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For your convenience, you may complete new patient forms in advance. Please select and print from the options below, fill them out completely and bring them with you to your appointment. If you are not able to complete the forms before your physiatry visit, please arrive at least 15 minutes early to complete these forms in the office before you see your physician.

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We recommend that you:

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• Bring your insurance card and photo ID.

• Bring a list of all current medications.

• Please arrive a few minutes early to fill out paperwork.

• At your request, we can also send you our New Patient Information Packet in advance to fill out and bring to your first appointment.

• Bring a copy of any important prior records if you are transferring your care from another doctor.

• Please bring any imaging relevant to your visit to our office.

 

Note that if a co-pay is required by your insurance company, it is due at the time of your visit and may be paid in cash, by check or with a credit card.

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Downloadable Resources: ​

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• New Patient for Procedure Package

• New Medicare Patient for Procedure Package

• Legal Representatives Medical Request Form

• Medical Records Release Form 

• Financial Information for Procedures

• Ultrasound Out of Network Policy

• Procedure Information Brochure

• Advanced Beneficiary Notice

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Payment Policy

 

Due to recent changes in healthcare plans, some patients have questions regarding patient and insurance responsibility for services rendered. Our rates are representative of the usual and customary charges for our area. Please review our payment policy information below.

 

You will be provided with a copy of this information to read and sign at your office visit. Please let us know if you have any questions or concerns.

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Insurance

We participate in most insurance plans, including Medicare. If you are not insured by a plan we do business with, payment in full is expected at each visit. If you are insured by a plan we do business with, present your current card at your office visit so that we may verify your coverage. Knowing your insurance benefits is your responsibility. Please contact your insurance company with any questions you may have regarding your coverage.

 

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Co-payments and Deductibles

All co-payments and deductibles must be paid at the time of service. This arrangement is part of your contract with your insurance company. Failure on our part to collect co-payments and deductibles from patients can be considered fraud. Please help us in upholding the law by paying your co-payment and/or deductible at each visit.

Payments can be made in the form of cash, personal check or credit card. We accept MasterCard, Visa, Discover and American Express.

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Coverage Changes

 

If your insurance changes, please notify us before your next visit so we can make the appropriate changes to help you receive your maximum benefits. If your insurance company does not pay within 30-60 days, you will be responsible for the balance.