Once you schedule, please call the clinic so we can collect some information from you in order to sign you up for the patient portal. We will also email you the intake form, consents and the insurance verification form to complete prior to your appointment.
For your convenience, you can also download the forms in the following sections:
Patient Intake Form
The patient intake form helps you to provide us with contact information as well as your current and historical general health and wellness. It gives us a broad overview and a starting point for getting to know you and your health care needs.
Insurance Verification Form
The insurance verification form is the form you will you use to make sure you obtain needed information when you call your provider to verify your insurance coverage (e.g. providers and services that are covered in and out of network, deductibles, number of visit limitations, etc.).
Release of Records Form
If you have any lab or imaging records from the previous year from another provider, please fill out the Release of Record Form. You can either submit to the outside provider yourself or email the completed form to us and we will coordinate for you.
The following consent form will need to be reviewed and signed prior to your first appointment. The HIPAA Privacy Practices is a more detailed explanation of our policies for your reference. The Good Faith estimate and Fee schedule reviews the codes we commonly bill with both insurance pricing and self-pay pricing for those not using insurance.
- Consent and Polices Signature Form
- Clinic Policies and HIPAA Privacy Practices
- Good Faith Estimate and Fee Schedule
Please send these completed forms to email@example.com at least 2 days prior to your visit if you do not complete them in the patient portal.