The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time, you will save a significant amount of time during your visit. Please be prepared to provide this information to our office along with your current medical insurance information. If you have any questions when filling out these forms, please do the best you can and our staff will assist you with your questions on the day of your visit.
Note: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here or on the Get Adobe Reader icon.
We participate with many insurance companies. Listed below are a few of the plans with which we participate. Due to the rapid changes in the insurance industry, we ask that you contact your insurance company directly to inquire if our physician is a participating provider in your plan. Be sure to bring your insurance card(s) to each office visit. If your insurance company requires the use of referral forms or authorization numbers, it is your responsibility to request the referral in advance of services being rendered. You will be expected to pay for co-pays at the time of your visit. Any patient who does not have medical insurance will be required to pay for the visit at the time of service, unless prior arrangements have been made. You can do this by contacting the Accounts Receivable Department. Methods of payment are cash, check, Visa and MasterCard.
Should you have any questions or concerns you can call the Accounts Receivable Department at
(410) 377-7611 or (877) 554-2020.