Patient forms -
Click a link to download form
24-Hour Cancellation Notice (PDF)
Patients Insurance Coverage (PDF)
Medical Release-Payment (PDF)
HIPAA Consent (PDF)
Insurance
We accept the following insurance programs and their subsidiaries.
BC/BS—Anthem
Cigna
Southern Health
Medicare
Tricare For Life
United Healthcare
Aetna
MAMSI:
Optimum Choice, MDIPA, Alliance
Optima Health
Co—Payment
Insurance co-payments are expected at the time of arrival. If you are unable to provide this, please see the receptionist upon arrival for rescheduling of your appointment.
Please note: There will be a $25 fee for any returned checks.
Initial Consultations
We request that your referring physician contact our office to set up your initial consultation visit. The referring physician’s office must also fax to our office any notes regarding your previous care 48 hours prior to your appointment; if they do not, we may have to reschedule your appointment.
Please be certain to bring your insurance cards and a photo identification to your visit.
You should also bring a complete list of your medications, including the strength and dosing instructions.
Referrals & Authorizations
You must obtain a referral from your physician (primary care or other referring physician) prior to your appointment.
If your insurance requires authorization for a visit to a specialist you must also obtain this authorization number prior to your visit.
Message Service
Due to the high volume of telephone calls, we request that if you get our answering service, please leave a complete message including your full name, a telephone number where you can be reached, and your reason for calling. All messages will be answered after 4pm.
Medications & Refill Requests
You must discuss your medication needs, including refill requests, with the practitioner at the time of your appointment.
Medications should be taken only as prescribed; please do not request early refills of your medications. |