New Patient Registration
Linked below are new patient forms needed for your upcoming appointment. Please print and complete the first three forms (the Acknowledgment of Receipt of Notice of Privacy Practices, the Patient Information sheet and the Payment Policy) and return them by mail or fax, as soon as possible, along with a copy of your insurance card (front and back). If your insurance requires a referral and you have received it, please enclose a copy of the referral. We must have a copy of your insurance card (front and back) in order to verify benefits and be prepared for your visit. The “Notice of Privacy Practices” is for your records and we do not need it returned.Please note that patients who do not cancel their appointment 24 hours before and/or miss their appointment will be charged $25.00 for a missed routine visit and $100.00 for a missed surgical procedure.
Thank you, in advance, for your cooperation in assisting us with being prepared for your appointment. We hope your visit is a pleasant one.
