+ Patient Paperwork
Please download the appropriate form as directed by your physician and/or staff by clicking on the name of the form below. Please bring the completed form(s) with you to your scheduled visit. This will help expedite the registration process. Thank you.
- Patient Registration
- Financial Policy
- HIPPA Privacy Document
- Patient Medical Profile
- Narcotics Policy and Agreement
- Request for Records
- Spine History
+ Insurance Information
PLEASE BRING YOUR INSURANCE CARD WITH YOU TO EVERY APPOINTMENT
We participate with most federal and state government programs, and with the following insurance plans and provider networks:
- BlueCross BlueShield
- Community Health Network
- Health InfoNet
- New West
- United Healthcare
+ Appointment Information
Please call the office to make an appointment in advance. If you are unable to keep your appointment, please call us as far in advance as possible so we may use that time to see another patient in need of care. We make a sincere effort to adhere to our appointment schedule and appreciate your patience if we are late due to emergencies or hospital surgery.
Late Arrival Policy: Please be aware that if you are 15 minutes late for your scheduled appointment time or designated arrival time for your MRI, we may be required to reschedule your appointment to maintain a timely and efficient clinic.
+ Fees and Payments
We accept cash, check, debit card, Health Savings/Flex Card, American Express, Discover, MasterCard, and Visa for your convenience. If we are a participating provider with your insurance company, we will bill them. However, payment is the patient’s responsibility and is due at the time of service. A 15% discount will be applied to the bill if paid at the time of service if you are a self-pay patient and do not have insurance. We will help in any way we can to assist you in handling claims and balance management.
+ Prescriptions and Renewals
If you require a refill on your medication please contact your pharmacy. We require a 48 hour notice for all refills. No narcotic medications will be renewed after 2 p.m. on Fridays, nor on weekends, holidays, or after regular working hours by on-call medical personnel. Prescriptions will not be refilled outside of normal office hours because the covering healthcare provider or staff may not know you or your condition, and medical records may not be easily accessible. Please count your pills regularly and plan ahead for refills.