• X-rays, reports, test results
• Insurance Card
• Referral
• Co-pay
• Workers’ Compensation information

X-rays, reports and test results

You will need to obtain any recent x-rays, lab results or physician visit reports that relate to this problem that will be evaluated at your visit.  Please bring the x-rays and reports yourself since you cannot always depend on others to get them to the office in time for your appointment.

Referral

Obtain a referral from your primary care physician if your insurance carrier requires one.

Insurance Card

Bring your insurance card. We will make a copy of the card for your records.

Co-pay

• You insurance may require a co-pay that must be paid at the time of your visit.  Please bring some form of payment. We accept cash, Mastercard, Visa, and American Express.
• A copy of our financial policy can be downloaded here. A new copy of this form must be completed each calendar year.
• You will need to complete an medical questionnaire for any of the following reasons:
• If this is your first appointment
• If it is an appointment for a new problem not previously evaluated in the office
• If you have not been seen in the office for a year
• You can download a copy of the medical questionnaire here and complete it before your visit.
• We will need to know:
• The history of this current problem with any related treatments
• Medical conditions
• List of surgeries
• Medications and dosages
• Allergies and reactions
• Herbal supplements
• Use of tobacco, alcohol, drugs
• Family history of significant medical conditions

Workers Compensation

• If this is a work-related injury:
• Please bring a copy of the first report of your injury including your claim number.
• Bring any x-rays or reports that relate to this injury.
• You will also need to provide us with your health insurance information and follow the guidelines of that policy.
• Even if this is a work-related injury, we ask that you comply with our request for this health insurance information in order to protect you from becoming responsible for expenses that accumulate if workers’ compensation should ever deny your claim.
• If workers’ compensation never contests or denies your claim, we never use the health insurance information.
• If, for any reason, workers’ compensation contests or denies your claim we can submit the charges to your health insurance only if you have followed their rules and have obtained a referral, if required.
• If workers’ compensation denies your claim and you have not provided us with your health insurance information or followed the guidelines of your policy, you are responsible for all charges.
• It is for your protection.

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