Prior to your exam, there are a number of forms to fill out that will help us in our assessment. We have some of the forms available for you to print and complete prior to your visit to the office. This will save you time when you come in.
If you do not have a printer, the forms will be given to you at your first visit. Please read over the forms so you will have the information with you.
For group health or personal insurance billing we will need a copy of your insurance card to verify benefits and to get the information on where to bill the claims. You may print the insurance verification form and check with your insurance carrier so that you will know what your coverage is prior to your visit.
If you have been involved in an Auto Accident and wish to bill auto insurance for your services we will need several pieces of information: (1) your car insurance information, (2) your group health information, (3) a copy of the accident report if available. Our office policy is to bill your auto policy’s medical payments portion and or your major medical insurance. We will not bill and wait for payment from a third party or attorney.
For Workers Compensation claims we are required to have verification of the injury with a superior at your employer. You will have you fill out a workers compensation questionnaire about your injury and your job requirements, and information on where to send the bills.
Please review, complete and sign all of the required forms. The forms below are in .pdf format. A link to Adobe for Acrobat reader to view these form in .pdf is available below.
If you have Health Insurance or are a Cash patient please download and complete only this form below.
Health Insurance/Cash Patient Forms
If you have been involved in an Auto Accident please download and complete only this form below.
Auto Accident Patient Forms
If you have been involved in a Work Related Injury please download and complete only this form below.
Work Related Injury Patient Forms
This site uses the Adobe Acrobat (.pdf) file format for printable documents. If you do not have the reader please click on the "Get Acrobat Reader" below so you may view and print our documents.
|
(Adobe.PDF File format)
For your convenience these forms are also available below in Word.doc format
Health Insurance/Cash Patient Forms
Auto Accident Patient Forms
Work Related Injury Patient Forms