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