Office Policies and Acknowledgment
Appointments:
We request that patients arrive at least 10 minutes prior to their scheduled appointment time. Late arrivals may be rescheduled to ensure all patients receive the quality care they deserve. If you need to cancel or reschedule an appointment, please notify us at least 24 hours in advance. Repeated no-shows or late cancellations may result in a cancellation fee.
Insurance and Payments:
It is your responsibility to provide accurate and current insurance information. We will assist in processing your insurance claims; however, all charges are ultimately your responsibility, whether or not covered by insurance. Co-pays, deductibles, and any uncovered services are due at the time of service.
Medical History:
It is essential that you inform us of any changes to your health, medications, or allergies. Accurate and up-to-date information ensures we can provide you with safe and effective care.
Financial Responsibility:
I understand that I am financially responsible for all charges for services rendered, including balances not covered by insurance. I agree to pay any collection fees or attorney fees in the event my account is turned over for collection.
Photo and Document Uploads:
By submitting photographs (including a chart photo), driver's license, and insurance documentation, I consent to their use for administrative and treatment purposes in accordance with privacy laws.
Privacy Practices (HIPAA):
We are committed to protecting your medical information. A full copy of our Notice of Privacy Practices is available upon request.
Consent to Treatment:
I authorize the staff and providers of this office to perform examinations, diagnostic procedures, and treatments as deemed necessary. I understand that no guarantees have been made regarding treatment outcomes.