Patient Information and Forms

New Patient Paperwork

Download the PDF. Fill out the paperwork on your computer. Print and bring to your appointment.

What to bring with you to appointments:

We ask our patients to bring their current insurance card and driver’s license.

What to do if your insurance requires a referral:

Patients with insurance plans that require a formal written referral such as an HMO (Health Maintenance Organization), EPO (Exclusive Provider Organization), or POS (Point of Service Plan), please contact your Primary Care Physician (PCP) prior to your visit to obtain a referral if one is needed.

What to do if you had an injury at work or in an auto accident:

If you were injured at work or in an auto accident, we request a letter of authorization from either the auto insurance company or the worker’s compensation carrier. This letter needs to have the name, address, phone number, and claim number of the insurance company responsible for payment. This letter should also include the name and phone number of a contact person at the insurance company. Your insurance company can either mail or fax this letter to us.

What to do if your insurance company does not cover visits or supplies:

If your insurance company does not pay for office calls or supplies, if you have a co-pay, or you are do not have coverage, we ask that services be paid at the time of your office visit.

Payment options:

Our office accepts personal checks, Visa, Master Card, Discover Card, and Care Credit.

Other information:

I encourage you to make a list of any questions you may have. Our practice is built on the principles of caring and commitment to our patients, offering the highest quality and the latest proven technology. It is important for us to provide trust and confidence and to demonstrate to you that we will be your best advocate.