Please complete BOTH of the following forms and bring to your appointment, along with your insurance card.

PatientDemographic.pdf
PatientInfoSheet.pdf

Procedures Covered by Insurance:
If your health insurance requires a referral to a specialist office, please contact your primary care physician to set up the referral prior to your apppointment. We will contact your insurance carrier after your visit for any necessary authorizations. A co-payment will be collected at the time of your visit.

Cancellation Policy:
Please contact our office if you are unable to keep your appointment. If you cancel your appointment less than 24 hours in advance, you will be charged a $50.00 cancellation fee. We attempt to accomodate our patient's schedule to the best of our ability. Please contact us as soon as possible to cancel any appointments, so we may accomodate another patient. Please be advised that if you do not show for two consecutive appointments, another appointment will not be made.

Consulation Fee Reminder:
The consultation fee for our physicians is $110.00. This fee will be collected at the time of your visit. The fee is applied to the balance of your surgery.

If you have any questions regarding your appointment or the forms enclosed, please contact our office. For directions, click here.