Forms & Information
Please complete and bring all applicable forms to your first appointment.
New patient forms
General forms
Information/documents to have on hand
Be advised if any of the required information listed below is missing, we may need to reschedule your appointment.
- Insurance card(s)
- Valid driver’s license or government-issued photo ID
- Insurance policyholder information – this is the person who holds the policy under which you are covered
- Policyholder’s name
- Policyholder’s social security number
- Policyholder’s date of birth
- Name of policyholder’s employer (if applicable)
Photo for your medical records
Properly identifying patients is the first step in assuring safety in any healthcare system. Proper identification can prevent treatment errors and “wrong person” procedures and can safeguard patients against privacy violations, billing errors, insurance fraud, and even identity fraud.
Photo at check-in: For patient safety and identification, please be advised that patients checking in at our office for their appointment will have their photo ID scanned to be applied to their electronic medical record. The photo will be stored in your file to identify you on future visits. We will only need to take your picture once.
Copays & deductibles
- Please be aware of your insurance copay, deductible, and coinsurance.
- Specialist copays may not cover all diagnostic services performed in the office. Please contact your insurance carrier to determine individual benefits.
All copays, deductibles, and coinsurances are collected at the time of your visit with no exceptions.