Online Services
Patient Forms
For All Patients
Patient Forms Packet
Please print the forms packet below, complete it, and bring it with you to your appointment.
- Patient Forms Packet
- HIPAA Notice of Privacy Practices - Please Print for Your Records
Individual Forms
If you need an individual form, please choose from the list below.
- Patient Registration
- Assignment of Benefits
- Medical Information Release Authorization
- HIPAA Notice of Privacy Practices
- Privacy Practices Acknowledgement
For Medicare Patients
Please learn more about Medicare and Wellness Visits. Our Medicare Wellness Questionnaire can be found below. Please print and complete it, and bring it with you to your appointment.
Insurance Accepted
If your insurance plan is not listed below, please contact us as we may have recently joined your insurance plan's network.
- Aetna
- Aetna Medicare
- Beech Street
- Blue Cross Blue Shield
(all products including exchange) - Blue Cross Blue Shield Medicare
- Cigna
- Cigna Medicare
- Coventry
- Coventry Medicare
- Eon Medicare
- Evolutions PPO
- Humana
- Humana Medicare
(except Humana Medicare HMO) - Medicare
- Multiplan PPO
- Nova Net PPO
- PHCS PPO
- Tricare
- United HealthCare
- United HealthCare Medicare
- Wellcare Medicare
Appointment Policy
About Your Appointment
- All patients, please bring your insurance card and photo ID to each appointment.
- We request you bring all medications you take, prescription and over the counter, in their respective bottles to your visits.
- Please arrive before your scheduled appointment time. If you arrive 20 or more minutes past your scheduled appointment time you may be asked to reschedule your visit.
- Fasting appointments: If you are asked to come to your appointment fasting, we ask that you do not eat or drink anything (EXCEPT WATER) 12 hours prior to your appointment. Please drink water so that you are well hydrated, this helps with the blood draw. Not being well hydrated may negatively affect some of your results.
- You may take your morning blood pressure medication. You may take any of your morning medications that are acceptable to take on an empty stomach. Please call if you have questions.
Appointment Cancellations
If for any reason you cannot make your physical appointment, please contact our office 24 hours in advance to cancel or reschedule your appointment. Failure to do so will result in a $50 fee that will be charged to your account. This procedure has been put into place to limit the amount of "no show" wellness exams so that we can provide sick patients the opportunity to be seen by their physicians.
