For your convenience, you may complete the new patient form in advance. Please select and print from the option below, fill it out completely and bring it with you to your appointment.
If you are not able to complete the form before your visit, please allow at least 30 minutes for completion in the office before you see the doctor.
Personal Identification Needed
Be sure to have your valid driver license or identification card and insurance card(s) with you.
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. Co-payments or full payments may be due upon your visit depending on your coverage. Please let us know if you have any questions or concerns.
We participate in most insurance plans. 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.
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.
If your insurance changes, please notify us before or on your next visit so we can make the appropriate changes to help you receive your maximum benefits.