Patient Forms

Quickly and conveniently obtain forms from our office. To view the forms listed below, you will need Adobe Reader. You may bring your completed forms to the office at the time of your visit.

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• Release of Records
• Notice of Privacy Practices

Policies

Financial Policy

• Payment for co-pays are due in the day of service. We accept cash, check and credit card (MasterCard and Visa).
• We will bill all insurance companies provided the patient has obtained all referrals necessary.
• If we do not participate with an insurance company, payment is to be made in full by the patient on the day of service and we will courtesy bill the insurance company for the patient on an unassigned basis, which means the patient, will receive the payment from the insurance company.
• Not all services are covered by insurance. If the insurance company denies a claim due to medical necessity, the patient will be responsible for the bill.
• Patient bills are sent on a monthly basis. Payment is due upon receipt of this bill.