For new patients who would like to book an appointment, please return the requested information below via email to email@example.com.
Before we book you an appointment, we must have these forms filled out and returned. Receipt of your forms will be taken as acceptance of our new protocols described below.
Be aware of your insurance coverage beforehand. We are unable to look into your benefits. We must have your completed Insurance Authorization Form in the system prior to your appointment to be able to bill your insurance electronically.
Reminder, please check all boxes and sign all forms.
Please be aware of the protocols below prior to emailing your paperwork.
Once these are all received and added into our system, we will contact you for an appointment.
If you are running late, please be aware that we may not be able to accommodate your appointment.
Please notify our office at least 24 hours prior to your appointment. Failure to do so will result in a minimum charge of $50 up to the full cost of the exam. Future appointments will only be fulfilled after the balance is paid in full.
We look forward to hearing from you.