Patient Forms

For new patients, these forms are here for completing prior to your scheduled appointment.  If you are unable to complete these forms before your appointment, we ask that you arrive 15 minutes early and please be sure to bring a valid ID (driver’s license) and your insurance card.  If this is your first visit with us, please bring all your medications with you to your appointment.  For existing patients, these forms need to be filled out on a yearly basis.

All Patients

Welcome Form

Patient Registration Form

Health and Medical History Form

Email Consent Form

Prescription History Consent Form

OTC Policy

HIPAA Form

For Children

Parental Consent Form

HIPAA Signature Form for Children

For Adults

HIPAA Signature Form for Adults

 

Inclement Weather

Please refer to channel 9 WSOCTV.  If you contact our office, our recording will notify you if our office is to be closed and/or what our hours of operation will be.
If our office is closed, please do not leave a message for the receptionist.  If you have an emergency call 911 or go to the emergency room.

 

No Show/Missed Appointments

Our policy is to charge for missed appointments not cancelled within 24 hours preceding the date of your appointment.  These charges will be your responsibility within 24 hours preceding the date of your appointment.

 

Reminder Pro

Is an interactive calling system that will contact our patients 24 hours prior to their appointment to advise them of date and time of appointment.  The patient can confirm receipt of the call, confirm or cancel the appointment, or it leaves a message on your answering machine.

 

Insurance

We participate in most insurance plans, including Medicare, and several medicare advantage plans.  If you are not insured by a plan we do business with, payment in full is expected at each visit and we will file your insurance and refund you any payment due you.  If you are insured by a plan we do business with, but do not have an up-to-date  insurance card, payment in full for each visit will be required until we can verify your insurance coverage.  Knowing your insurance benefits is your responsibility.  Please contact your insurance company with any questions you may have regarding your coverage.

Appointment Request