First Visit Checklist:

Verify your insurance benefits with your insurance company.

 

Fill out the Patient Demographics-Insurance sheet PRIOR to your visit and bring with you.

 

Review and sign Authorization for Use/Disclosure of Health Information

 

Review and sign Communication Guidelines, Insurance, and Cancellation Policy

 

Review HIPAA Notice of Privacy Practices form and sign HIPAA Signature Form 

 

Be prepared to provide a credit card which will be kept on file in a safe, secure locked location. Your credit will only be charged in the event there is a problem processing your claim. 

 

Please carefully read the New Patient Liability Form. Please initial each paragraph, fill in your credit card information and sign/date acknowledge you agree with the information stated in the document.

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Still have questions? No problem!  Call (908) 307-8066 or email Kerry at kerrylconlon@gmail.com