Patient and Practice Information

Contact Information

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Forms & Patient Information

The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time you will save significant time at the time of your visit. If you have any questions when filling out these forms, please do the best you can, our staff will assist you with your questions on the day of your visit.

Please printout and complete the appropriate forms: 

Note:  Most of the above documents are in Adobe® PDF format. They require Adobe Reader to be viewed. If you do not have Adobe Reader, you can download it for free by clicking here.

Insurance Information

We are non-participating with Novitas Medicare Solutions; however we do process and submit the claims. Novitas Solutions establishes the allowable fees we may charge, and reimburses the beneficiary directly and forwards the claim to the secondary carrier if a crossover has been established. For all other healthcare plans, we do process and submit the claims and all payments are reimbursed to the insured.

Our billing department is always available to address problems which may arise, and answer any questions you may have.  We make every effort to correct any errors and work on behalf of our patients.

Our Enhanced Services are typically not covered by insurances.  The Enhanced Services do not cover your medical visit, only the enhanced Time, Access, and Wellness offerings, therefore you may still wish to have insurance.  Contact your HSA or insurance company as well as my program partners, Paragon Private Health, should you have question regarding the fees, billing, and how insurance works with the enhanced program.