Patient Registration Forms

formsYou may access the following forms to assist us with your care. Please print and fill out the following forms, then bring them to your appointment.

Office No-Show and Cancellation Policy

We understand that there are times when you must miss an appointment due to emergencies or other obligations. However, when you do not call to cancel an appointment, you are likely preventing another patient from receiving much needed treatment. Conversely, the situation may arise where another patient fails to cancel and we are unable to schedule you for a visit, due to a seemingly “full” appointment book. Due to this critical fact, if an appointment is not cancelled at least 24 hours in advance you will be charged a thirty dollar ($30) fee; this will not be covered by your insurance company.

We understand that delays can happen. However, we must attempt to keep the other patients and doctors on time. If a patient arrives 15 minutes past the scheduled appointment time, we reserve the right to reschedule the appointment at our discretion.

We will require that patients with self-pay balances do pay their account balances to zero (0) prior to receiving further services by our practice. Patients who have questions about their bills or who would like to discuss a payment plan option may call and ask to speak to an Office Manager with whom they can review their account and concerns. Patients with balances over $100 must make payment arrangements prior to future appointments being made.