1. Your current insurance card. In order to accurately account for your visit, you must bring your insurance card with you each time you have an appointment. If you do not have your insurance card, you will be required to sign a promissory note accepting responsibility for all charges. Your insurance company requires us to review your insurance card(s) at each visit to ensure timely and accurate billing, reducing your financial burden. If patients don’t bring insurance cards they will be expected to pay that day for services rendered.

2. Any co-payment you may owe with the visit. If your insurance company requires a co-payment or deductible, we are required to collect this at the time of service. Please verify the amount of your co-pay or deductible before your visit and be prepared to pay this amount at the time of your visit.

3. General and Health information forms. At a minimum of once each year, you will need to update your information sheet. Again, this is to ensure accurate information for billing purposes. Your insurance will deny any claim with inaccurate information. We also need current information in case we need to contact you. Your personal information is private and secure. Federal law requires your permission to discuss health status, referrals, and lab results with others. Health history form, General Information form, Review of systems form.

4. Any child under 18 must either be accompanied by a parent or guardian or possess a written note granting us permission to treat him/her in your absence. You may download Permission to treat a minor form.

5. Arrival time. As a courtesy to our providers, staff and other patients, please arrive early for your appointment. This will help to ensure that you are seen at your scheduled time. Late patients penalize those who have arrived on-time and inconvenience patients and staff. Out of respect for others, if you are late for your appointment, you may be asked to reschedule.

Click on the forms below to download a printable Acrobat PDF file or Microsoft Word document
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First Visit...

• Insurance Card
• Patient Information Sheet ~ PDF
• Health History Form ~ PDF
• Promissory Note ~ PDF || WORD

• Insurance Card
• Patient Information Sheet ~ PDF

• Insurance Card