Appointments

There are a total of 4-5 forms you will need to have.

	Medical History Form 91 KB
	Minor Patient Information Form (Minors Under the Age of 18) 58 KB
	Insurance Form 121 KB
	HIPAA Form 35 KB
	Authorization for Treatment Form 151 KB

In addition to these forms you will be responsible for
bringing the following:

Current Photo ID

Insurance Card

Referral if required by your insurance

Any reports (I.E. CT reports or X-ray films)

If you have Power of Attorney over the patient, you are required to bring all the necessary paperwork to the appointment.

It is required by law for all minors to have a parent or guardian with them to be seen. If the parent or guardian is unable to accompany the patient to their appointment, they must have an authorization stating who may bring the patient to their appointment.

Insurance

Some of the plans with which we participate include:

We participate in the BCBS PMD program. Please call the office if your insurance is not listed.