Medical Forms

Prior to your first appointment at the Center, a patient information packet will be mailed to you to complete, sign and bring to your appointment. You also can download these forms with Adobe Acrobat.

Insurance and Billing

Please bring your insurance card to each appointment so that the receptionist can make a copy.

Co-payments are expected at the time of service and should be paid to the receptionist prior to seeing the physician. The Center accepts several forms of payment, including MasterCard, Visa, check and cash.

We will gladly submit your charges to your insurance carrier(s). Please keep in mind that you, as the patient, are ultimately responsible for your bill. The billing department will be glad to answer any questions or concerns regarding your insurance and billing.

If you are being seen under a Workers’ Compensation claim, it is important that we have your claim number, date of injury, employer at the time of injury, and all conditions. In addition, we will also need written authorization from your Managed Care Organization (MCO), or your employer, prior to your appointment. If you cannot provide this information by your appointment date, please call our office as soon as possible.

Please notify your primary care physician prior to your appointment with our office if you are covered by an HMO that requires a referral to our office.

Please keep in mind that Medicare and other insurance companies may not pay for durable medical goods (ace wrap, foot supplies, wheelchair cushions, canes, etc.). It’s a good idea to become familiar with the rules of your health plan if you are injured.

 

Download Medical Forms

New Patient Information Packet

Registration Form for New Spine Patients

Authorization to Release Health Information Form

Self Pay Financial Policy

Financial Policy Regarding Motor Vehicle Accidents and Liability Injuries