New Patient Request
New Patient Request
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New Patient Request

NEW PATIENT REQUEST

OFFICE STIPULATIONS FOR ALL NEW PATIENTS TO UNDERSTAND AND ACCEPT BEFORE THEY PROCEED:
  • We highly advise reading through our website to learn more about our providers and office prior to requesting a new patient appointment
  • Make sure we are in network with your insurance company
  • We do not perform any pain management or prescribe chronic pain medication
  • We do not prescribe Xanax or other addictive controlled substances
  • We do not treat or prescribe medications for ADD/ADHD
  • Ultimately our providers have the right to use their prescription privileges as they see fit in regards to types of medications or quantities
  • Patients receiving treatment from mental/behavioral health specialists must continue to see those specialists/prescribers as we are not a replacement for those services
  • All patients are expected to be compliant with their health conditions and prescribed medications
  • The initial appointment will be to establish you as a patient of this office, and address any immediate concerns you may have. The initial appointment is not a physical
  • All financial responsibilities to include copays, coinsurance and deductibles will be collected at time of service
  • All children must be vaccinated on schedule, we do not delay immunizations
  • All adults must submit their own request for a new patient appointment, we do not allow other adults to request appointments on behalf of other adults
  • You must not provide any Personal Health Information through email or other electronic format
OFFICE STIPULATIONS AGREEMENT(Required)
ABOUT THE INITIAL SCHEDULING:
  • Individuals who have formerly been patients of our practice will not be allowed to return and our ineligible to use this requesting service
  • New patient appointments typically book about 3-4 weeks away. Until you have had this new patient appointment we will not treat or meet any health care needs you may have nor can we accept your health records
  • Upon receiving your new patient request, we will typically answer your request within 48 hours through email and provide a suggested date/time for your initial appointment. If you don’t receive any reply by email or phone within 2 business days you may call the office to inquire further
  • If you are unable to accept the appointment date/time we have set, you must CALL the office (not email) to reschedule as long as we are provided at least 24 hours notice prior to your appointment
  • If you fail to provide notice, at least the day before your appointment, to cancel or reschedule or you simply do not show for your first appointment we will not set any other appointments for you in the future
  • If you arrive more than 15 minutes late for your first appointment, we will cancel this appointment and will not reschedule
  • All of our providers “share” patients, and unless specifically assigned to one physician for insurance purposes, patients may see different providers from time to time depending on availability
  • If a patient is required to assign a provider by their insurance company (such as those with Blue Cross Blue Shield Select Plans), they must do so prior to their visit as will not be able to delay an appointment at time of service for you to coordinate your coverage
INITIAL SCHEDULING AGREEMENT(Required)
Name(Required)
Gender(Required)
Are you diabetic?(Required)
MM slash DD slash YYYY
###-###-####
Preferred day(s) of the week for appointment(Required)
Do you prefer morning or afternoon appointment?(Required)
Email(Required)