Please download and fill out the appropriate medical history form listed below. Please bring this form to your first office visit. The security and privacy of your personal information is our primary concern.
- History Form English (Coming Soon)
- History Form Spanish (Coming Soon)
- Medical Release Form (Coming Soon)
Prescription & Refill Policy
Prescriptions needing to be refilled require a minimum 48-hour notice to your physician.
During the evenings and weekends, the on-call physician does not know if a refill or prescription is indicated without the patient's medical records. Therefore, in practicing responsible medicine, the physician on-call will not refill prescriptions after-hours or on weekends or holidays.
Release of Medical Policy
Prior to the release of information concerning your health to any thirdparty, such as an attorney, other physician or insurance company, you must sign a special form authorizing release of this confidential information. This policy is to protect the privacy of each patient. There is a $25.00-dollar fee for medical records exceeding pages
Each patient's medical condition is unique, so medical fees vary according to the type and extent of services provided. We will promptly respond to any questions you may have regarding your statement. Please allow at least 24 hours in addressing any billing statement. Please call our business office , if you have any questions.
Billing & Insurance Policy
We will bill all insurance companies that we are contracted with. When charges, or any portion thereof, are rejected by these agencies, we expect payment from the patient upon receipt of the monthly statement. Some services/products rendered to the patient may have an out-of-pocket cost and will be discussed with the patient during their appointment.