• New Patient Forms (pdf)
  

Tricare and Medicare Patients

Your insurance still requires us to obtain your Social Security Number in order to verify eligibility, referrals, authorizations and to file claims on your behalf.   Please provide this number when filling out your paperwork.  If you do not provide this number, we will be unable to file your claims and therefore, you will be entered as a self pay patient.

Please remember to bring your insurance card and photo I.D. with you to EVERY appointment!!  

Our staff needs to verify your insurance and demographic information at each visit.   This may take a few minutes, but it is essential that we have the correct information to serve you best.

 Office Policies

Refills

Should you need a refill on your medication, please request one from your pharmacy.  Most prescriptions written by our office have refills.  Your pharmacy will be able to let you know if you have any refills left on your prescription.  They will usually contact us via fax seeking authorization if necessary.  Refill requests are usually handled within a 48 hour time period.  Please do not wait until the last minute to request a refill.  If you are overdue for a follow-up, you may be asked to schedule an appointment to make adjustments to your medications or to try something new before refill requests are approved.

Cancellations/Missed Appointments

We appreciate a 24 hour notice when an appointment must be cancelled or rescheduled.  Missed appointments are assessed a $50.00 No Show fee.  If you are more than 15 minutes late for your scheduled appointment, you may be required to reschedule your visit.

Under Aged Patients

No child under the age of 18 will be seen without the presence of a parent or guardian (with legal documentation).  After the initial visit and upon the parent's written authorization, a child of driving age may be seen without a parent provided they are able to furnish insurance cards, referrals and all necessary documents needed at the time of their visit.

Insurance/Referrals

It is your responsiblity to provide this office with updated insurance information at every appointment. If you do not provide us with a current/active insurance card and would still like to be seen by the physician, payment will be due in full at the time services are rendered.  Otherwise, you will be asked to reschedule your appointment.  Charges may include, but are not limited to, office visit, procedures, labs and pathology. 

It is also your responsibility to request a referral from your primary care doctor if your insurance requires it for you to see a specialist and to bring it with you or have it faxed over to our office prior to your appointment.  Should you not know if you need a referral to see us, please call your insurance company.  If we do not have the necessary referral when you come in, you will need to reschedule your appointment. 

Cosmetic Procedures

A $100.00 non-refundable deposit is required for all cosmetic and non-medically necessary procedures that are scheduled.  This deposit will be applied to the procedure after completion and will not be refunded should your appointment not be cancelled 48 hours in advance. Methods of payments are cash and credit card only.

INSURANCE PARTICIPATION

Our office participates with the following plans:

This list is subject to change and is not a guarantee of participation or payment.  The final determination is made by your insurance company.  Please contact them for verification.