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New
Patients
>>
Download Registration Forms
Your
First Appointment
There
are several things that we ask you to bring to your first visit.
Please plan ahead to be sure this information will be available;
this helps us to help you! They are:
- A
completed Permissions, Consents, and
Responsibilities Form that is enclosed with your New
Patient pamphlet.
- A
completed Patient Medical History Form
that was also enclosed with the pamphlet. This will assist your
physician in making a diagnosis, assessing, and treating your
present problem. This form also requests a list of your current
medications, the dose and how long you have taken each one.
- Your
insurance card(s), your driver's
license, and your Social Security
Number. We must make a copy of your insurance card(s)
in order to properly process your claim for you. We require your
driver's license and Social Security Number for identification
purposes.
- Any
lab or test results you may
have. This includes urine tests, PSA
results, x-rays, CAT scans, and ultrasounds. The x-ray
and CAT scan films are very important. You can check
them out of the radiology department and bring them to the office
visit with you. Your x-rays will enable us to reach a diagnosis
and begin effective treatment more quickly.
- A
referral if your plan (HMO)
requires it. We realize that insurance requirements can be difficult
to understand, and so we encourage you to learn all you can about
your plan’s requirements by calling the customer service
number provided for you. If you still need help, feel free to
call the experts in our office who can help you to be sure you
receive all your entitled benefits.
- Any
questions you may have for
your physician.We encourage you to write down your questions so
that you don’t overlook any. Our physicians want you to be
informed and will answer your questions so that you fully understand
your care and treatment.
Registration
Forms for New Patients
In order
to simplify your first visit, we encourage you to complete our "Permissions,
Consents, and Responsibilities" form (please complete either
the Adult or Pediatric version, whichever is appropriate) and the
Patient Medical History Form.
Please
mail or fax the completed form to the office where your appointment
is scheduled (click here for address
and fax information), or you may bring the forms to your first visit.
Please do not attempt to email the forms to us. (Note:
your computer must have Adobe Acrobat Reader, Version 4.0 or higher,
to open these *.pdf files. To download or upgrade Acrobat Reader,
click
here.)
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