Patient Forms:
Brief Patient History Form AARC
Patient Financial Responsibility form AARC
Authorization to release healthcare form AARC
HIPAA Compliance Patient Consent Form
No-show/late cancellation policy
Physician-Patient Arbitration Agreement
Telehealth Patient Consent Letter
Late Cancellation and Missed Appointment Policy:
This policy has been established to help us serve you better.It is necessary for us to make appointments in order to see our patients as efficiently as possible. No shows and late-cancellations cause problems that go beyond a financial impact on our practice and delay the delivery of healthcare to other patients.
A "no show" is missing as a scheduled appointment. A "late cancellation" is canceling an appointment without calling us to cancel 24 hours in advance of an office visit.
We understand that situations such as medical emergencies occasionally arise when an appointment cannot be kept and adequate notice is not possible. These situations will be considered on a case by case basis.
A charge of $25.00 will be assessed for each no show or late cancellation office visit appointment if less than 24 hours notice is given.
Please understand that Insurance companies consider this charge to be entirely the patient's responsibility.
Payment Options:
We accept all major credit cards, cash and personal checks.
