Patients
Patient Registration
All new patients must preregister with our office by filling out our secure online patient forms. We require the Patient Registration form, the Patient Responsibility form, and the Patient Privacy form. If you or a family member is visiting our Pediatrics or Specialists office, there may be additional online forms you will be directed to complete. After you have completed the forms please make sure to press the Submit button on the RIGHT to automatically send us your information. On your first visit to our office, we will have your completed forms available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.
Patient Responsibility Policy
It is important that you understand our policies regarding financial responsibility for health care. In general, it is the patient's responsibility to understand his/her benefits, deductibles, co-pays, and other specifics. We will bill your insurance as a courtesy, but payment for your share of cost will be expected at the time of your office visit. Please review our policies, and indicate your agreement with the policy.
Patient Privacy Notice - HIPAA
This form addresses your rights to the confidentiality of your medical record and usage of the information for the provision health care to you by our office and other providers (under the Health Insurance Portability and Accountability Act). In this form, it's important that you indicate any restrictions to disclosure, as well as to identify family members or others that may be allowed to know information about your medical condition. Additionally, we ask that you advise us of acceptable methods with which to leave messages or provide information to you about your health care.