Patient Information

Our Office Policies

{office_policy}

Mission Statement

{mission_statement}

Billing

The {prim_practice_name} accepts cash and personal checks as well as the following credit cards:

• {name}

We also accept these payment options :

• {name}

{office_billing}

Appointments/Cancellations

With the exception of serious emergencies, it is expected that you keep all of your appointments. If you need to reschedule an appointment we require 24 hours notice. In such a case, please call our office and arrange for a make-up appointment with one of our patient care coordinators.

{office_cancellation}

Emergencies

Our office provides on-call service for emergencies. Call {prim_number} so that the physician on call can be contacted.

{office_emergency}

Patient Forms

The {prim_practice_name} provides our patients with office forms for your convenience. We recommend you print and fill these forms prior to your appointment to save time.

• Patient Registration
• Medical History
• X-ray Records Release
• HIPAA Compliance
• Consent
• Financial Agreement

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

client consent form updated .pdf