Please complete your Patient Registration Form AND BRING OR SUBMIT:
1) valid I.D.,
2) insurance card and
3) a credit card, to be kept on file.
**We will charge your credit card the (insurance) contracted amount, if insurance does not pay, due to deductible, copays, incorrect insurance info and/or non covered services. **
***FOR TELE HEALTH APPTS:***
*DR WILL CONTACT YOU VIA THE EMAIL/CEL NUMBER THAT YOU USED TO BOOK YOUR APPT. PLEASE BE SURE THIS INFO IS CORRECT, AS IT WILL DELAY YOUR APPT. IF YOU NEED TO CHANGE YOUR CONTACT INFO, JUST CANCEL YOUR EXISTING APPT, AND SCHEDULE A NEW APPT WITH THE APPROPRIATE INFO.
*EXPECT AN INVOICE FOR YOUR COPAY, THE MORNING OF YOUR APPT, WE WILL SEND IT FROM OUR "SQUARE" APP. IT WILL BE EMAILED TO THE EMAIL ADDRESS THAT YOU USED TO BOOK YOUR APPT. BE SURE TO CHECK YOUR SPAM FOLDER TOO. THIS MUST BE PAID PRIOR TO YOUR APPT. FAILURE TO DO SO MAY CAUSE YOUR APPT TO BE CANCELLED**
Thanks for your cooperation!