In order to best serve your medical needs, we ask that you complete the following packet in full before your arrival to our office. Although we do appreciate any efforts to save our environment, we ask that you print out the packet as it is shown to you; single sided and in black ink. When filling out the packet, please use black or blue ink. If you are unable to comply with the aforementioned requests, please arrive 40-45 minutes prior to your appointment so that you can complete your paperwork in a timely manner. We appreciate your cooperation with us.
Please Complete All Forms
NOTE: If your child is here for an evaluation, have your child do the four Self-Assessment Forms while you complete the other paperwork. Look over your child’s responses and put a check mark beside any differences in perspective that you may have.
REGARDING INSURANCE PLANS
You can be helpful in preserving our ability to provide services to you under your insurance plan by making certain that you track the timely payment of your claim. If you do not receive an Explanation of Benefits (EOB) from your insurance company within 30 days from the date of your appointment, you should call them to check on the status of your claim. If you receive an EOB, but it shows that no payment was made to us, you need to call your insurance company.
Unpaid balances beyond 45 days will, by necessity, be charged to your credit card. Hopefully, your efforts and ours will meet with success.