2) Authorization to Release Information is be filled in by
All New Patients 18yrs or Older.
3) One of the following Allergy Questionnaires is also to be completed by ALL NEW PATIENTS:
4) Please bring these, completed and signed forms with you along with all medical insurance information. Your co-pay must be paid at the time of your visit.
*** ALL NEW PATIENTS – PLEASE NOTE THE FOLLOWING ***
- Many insurance plans now have a high deductible, meaning the patient is responsible for all or a portion of the Office Visit/Allergy Testing charge at the time of appointment. Call YOUR insurance company before your appointment — UNDERSTAND YOUR DEDUCTIBLE. Click Here for additional information regarding deductibles.
- It is your responsibility to notify the staff of ANY changes to your insurance. Failure to do so will result in you being responsible for ALL charges not covered,
- Due to the high demand for new patient appointments, if you are unable to keep your appointment, please call, at least 24 hours in advance to cancel, so that the appointment time can be filled. Failure to do so will result in not being granted another new patient appointment in the future.
- Any forms left for the doctor to fill out will require a $25 fee at the time the form is left with the office. This includes but is not limited to FML papers, letters to an employer or other letters, government or insurance forms, but excludes work excuses, school excuses, Food Allergy Action Plans, Asthma Action Plans, or any note written on a single prescription sheet.
- If your insurance requires a referral to see a specialist, it is the patients responsibility to obtain it from your primary physician and bring it with you to your appointment. Failure to do so will result in having to reschedule your appointment.