Information Release Consent Forms
You may use these forms to either request that medical records be sent to our practice, or to request that we send your records to another physician. If you are a new patient, you can fill out the form and bring it to your first visit. If you wish your mail records to be sent elsewhere please mail us the appropriate form. Please call with any further questions pertaining to the release of records.
New Patient Registration Forms
Please print and fill out the registration form and bring it to your first visit.
New Patient Registration form - Adult
If possible please print and fill out this registration form and bring it to your child's first visit.
New Patient Registration form - Child
Blood Pressure Monitoring log
Blood Sugar Monitoring Log
Calorie Counter Log and website
FOR EMERGENCIES DIAL 911
Call your pharmacy first. We will refill from your pharmacy’s request, as appropriate, Monday - Friday, 9:00 AM -11:30 AM and 1:15 PM-3:00 PM. No prescription refills after 3:00 PM weekdays nor on weekends. Please plan ahead. Prescription refills will not be granted to individuals who have not been seen within a year. Please allow additional time for refill of controlled substances. Please be aware that, by law prescriptions for certain categories of controlled substances need to be picked up in person.
Insurance and Payment
All PPOs accepted. Insurance claims are submitted by our office. Patient is responsible to ensure we are “in network”. Patient is responsible for copay amounts and out of network amounts. Deductibles and copay amounts are due prior to your visit. Cash, checks, Visa, MasterCard, American Express and Discover are accepted. Contact our Billing Department for further information. Nonpaying accounts are turned over to a collection agency for further action according to our office collection policy. For patients without insurance, please visit the Affordable Care Act marketplace at www.healthcare.gov
Calls and Questions
Contact our office as soon as you are aware of a need. A receptionist will take your message and your call will be returned, usually by an R.N., for further action. We prioritize calls according to medical urgency and we make an effort to return all calls by the end of the day. Non-urgent calls such as test results and referrals may not receive a return call until the next business day.
Allow 3-4 weeks to receive your test results in the mail. Please do not contact this offi ce before 3-4 weeks unless instructed by your physician. If you have not received your results after 3-4 weeks, then contact our office for your results.
Patients are responsible to know their insurance. If your physician has ordered a test or referred you to a specialist, contact your insurance to inquire if a referral or authorization number is required for the test or to see a specialist. Then please contact our office and let us know what is needed. Allow three days if your insurance company requires a referral or an authorization.
After Hours Phone Calls
After hours please call the main office numbers and follow the prompts. We use a service called PerfectServe for our messages and it is important to leave a brief message including your name, date of birth and phone number and to ALSO key in your phone number very carefully using your phone's keypad. There is only one doctor on call during the evenings and weekends so please give the physician 20 minutes to respond as he or she may be involved in an emergency with another patient. If you do not hear back within 20-30 minutes please leave another message. If your situation is a MEDICAL EMERGENCY please call 911 or go to the nearest Emergency Room. Do not call after hours to schedule appointments, check on referrals or request refills. In particular, no controlled substances will be refilled after hours.