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Patient Information


Please note that our office works hard to schedule appointments to minimize the amount of time you must wait for the physician. When you fail to appear for your appointment or cancel the day of your appointment, you have left an open space that could have been filled by another patient. This is counterproductive for our office and for other patients who may have needed that time period.

Patients may be charged $25 for follow-up appointments that are missed and/or not cancelled 24 hours before the time of the appointment, per individual insurance regulations. New patients are charged $70.


As you may know, insurance companies are increasing deductibles, co pays and coinsurance amounts. This causes you, our patient, to pay more of your own medical expenses. In order to ensure a positive patient-physician relationship, we want to be sure you understand and agree to our Financial Policy.

Insurance Overview

More and more government regulations continue to complicate healthcare. We understand that it can be difficult to get through the maze of information. We will assist whenever possible, but it is your insurance, you are the one that pays them for coverage. Co-pays, deductibles, referrals, co insurance are a function of your agreement with your carrier and those are your responsibilities.

Insured Patients

We will bill your insurance company for our services on your behalf. However, you remain solely responsible for the bill and must take any steps necessary to ensure that your insurer pays its share of these services. If your insurer fails to pay, you will be held responsible for full payment of all charges, unless limited by law. Keep in mind as a function of your insurance, you may have a financial responsibility for part of a service.

Insurance Co-pays

You are responsible for paying co-pays on the day of service, per your insurance contract. Failure to pay at the time of your visit can result in having to reschedule your appointment.


If your insurance company requires referrals you must have your referral in place (electronically or paper) on the day of your visit. If you do not have the proper referral we will have to reschedule your appointment.

Non-covered Services:

If you know your insurance will not cover a particular service, you must authorize us in writing and agree to the fee prior to the service being rendered.

Uninsured New Patients:

We request that you bring a minimum of $200 to your first appointment. If the treatment costs less than $200, we will refund the difference. However, if it amounts to more than $200, you must pay a minimum of $25 or 25% of the balance due (whichever is greater) each time you receive a bill. Failure to do so will result in being turned over to a collection agency along with having to find another provider. As always, we try very hard to work with our patients, so if you are having a problem please contact our billing office.


The recent healthcare changes have added more pressure to an already stressed system. As any business, we must be paid in order to continue providing services. If you fail to pay the full balance within 30 days we will send one additional bill, if that is not paid we may turn your account over to a collection agency. More importantly we will notify you that you will have 30 days to seek care from another provider.

Therefore, if you can’t make your payment within 30 days, you must contact the billing manager immediately to make payment arrangements and make regular monthly payments. We will do everything within reason to work with patients who are making a sincere effort to meet their obligations. However, it would be unfair to those who faithfully meet their obligations for us to continue to provide services to those who make no effort to meet those same obligations.

Bad Checks

We will charge a $25.00 fee for bad checks received.

Patient Forms

Note: These files are in PDF format and require Adobe Reader to be viewed. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here.

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