New Patients

Welcome

New patient forms are available for your convenience to print, fill out, and bring with you to your first visit. Please download, print and fill out the "New Patient Forms" and bring them with you when coming in to visit us for the first time. Also, make sure you bring any medications you are currently taking plus a legal form of personal identification plus any insurance information you have.

Current Medications

Please bring all medications you are currently taking to your appointment.

Personal Identification Needed

Be sure to have your valid driver license and insurance card(s) with you.

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.

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.

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.

Patient Forms

Textbox Section

New Patient Forms

In order to view or print these forms you will need the free Adobe Acrobat Reader installed.

DOWNLOAD ACROBAT READER

Other Patient Forms

Disclosure of Heath Information – Allow your information to be released to another family member or friend if needed
Consent To Treat Minor – Consent form to treat minor children under age 18
Medical Records Release Blank – Release of Medical Records Form to yourself or another provider
Medical Records Release – Once the form is completed it is submitted directly to the Datavant queue for processing.

Register at FollowMyHealth

We use FollowMyHealth for our patient portal. Please see the information below about registering and downloading the mobile app. To register a new account, click the sign up button.

SIGN UP

Download the FollowMyHealth App

For mobile devices such as tablets and smart phones, you must first download the free “FollowMyHealth” application from your phone or tablet app store.

DOWNLOAD FOR ANDROID DOWNLOAD FOR IOS