Before You VisitPAPERWORK INSTRUCTIONPlease complete all information on these forms and sign at the bottom of the patient information sheet. Please do not use nicknames, but do include a middle initial if you have one. Bring the completed forms with you when you come in for your doctor's appointment. (DO NOT MAIL THEM IN.) Please bring your insurance cards so we may make copies for our records.PAYMENTPayment is expected at the time of the visit. We accept MasterCard, Visa and the Discover card. If you have a co-pay, you will be responsible for the co-payment at the time of the visit. The charge for the initial visit may be at least $300.00. There are additional charges for required tests like x-rays and blood, urine and other laboratory tests. Some insurances apply co-pays to these as well.SPECIALIST REFERRALSThe following insurance companies require referrals from your primary care physician if you are seeing a specialist. You must call the primary care physician to make sure he/she has requested approval for a specialist visit from the insurance company. This referral must be authorized before the specialist can see you. The insurance companies are: Ochsner Health Plan, Tricare Prime (Foundation Health Federal), Proctor and Gamble, Dresser Industries, Coresource and Workers Compensation (All).WHAT TO BRINGWhen you come to see the doctor, please bring in all medications and all health insurance cards. If you were referred by another physician, please bring all lab and x-ray reports with you on the day of your appointment. Please come in at least 15 minutes prior to your appointment. Check in with the front desk. They will copy your insurance cards and give you further instructions.FORMSPatient Info FormPersonal History Form - Page 1 Personal History Form - Page 2 Personal History Form - Page 3 Personal History Form - Page 4 |
