New Patient Information
If at any time you change your mind, feel free to contact our office and/or make an appointment with the physician.

Financial Policy

Thank you choosing us for you healthcare needs. Our goal is to provide and maintain a good physician-client relationship . The following is our Financial Policy, which we ask you to review and sign prior to your first visit.
(Initial) Your co-payment, deductible, coinsurance, or payment in full is due at the time of service. We accept checks and cash at this time.
(Initial) We participate in a wide variety of managed care plans. We are happy to bill your insurance carrier as a courtesy to you. We suggest that all patients review their health coverage with their carrier prior to receiving services or treatment. It is the responsibility of the patient to notify us of any changes in the insurance policy. Your insurance policy is a contract between you and your insurance company and our staff will not know the therms of your insurance policy. Please be aware that some, perhaps all, of the services provide may be non-covered services and not considered reasonable and necessary under the Medicare program and/or other medical insurances. The patient/financial guardian will be responsible for any remaining balances,. Additionally, it is your responsibility to obtain and track referrals for your visits.
(Initial) Patients without insurance are expected to pay at the time of service.
(Initial) we will bill your employer's worker's compensation insurance carrier and follow all other procedures as required by the states worker's compensation laws. As the patient, it is your responsibility to notify us prior to the with appropriate worker's compensation policy information.
(Initial) Due to state laws surrounding auto insurance payments, as well as payments delays, we regret that we may not be able to bill third party administrators in liability cases. In addition, we cannot suspend our normal billing and collection process when services are rendered. Your health insurance carrier or the guarantor will be billed for services.
(Initial) There will be a $30.00 returned check fee on all returned checks. In the event that a check is returned for insufficient funds, we reserve the right to call your bank for any future checks that are presented for payment on your account.
(Initial) Unless cancelled at least 24 hours in advance, your appointment could be considered a no-show. Our policy allows us to charge up to $25.00 for these types of missed appointments. Please help us serve you better by keeping your scheduled appointments.
Thank you understanding our Financial Policy. Pleases let us know if you have any questions or concerns. Please sign below to express your understanding and agreement to this financial policy.