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
  • Patients receiving treatment from mental/behavioral health or pain specialists should continue to see those specialists/prescribers as we are not a replacement for those services
  • 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:

  • • New patient appointments typically book about 3-4 weeks away. Until you have had this new patient appointment we will not be able 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
  • This initial new patient appointment will not be an annual physical exam; but instead it will be an opportunity for the doctors to gain knowledge about your medical history and treat any acute concerns you may have. Afterwards you may schedule your annual physical exam for a later date.
  • 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
  • • 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 or preference
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)
Do you prefer a certain doctor or first available?(Required)
Email(Required)