Our Clinic Policies
All patients must complete our Patient Registration form prior to seeing the doctor
Payment in full is required at the time of service. Refusal to pay for services rendered or to make a financial arrangement will result in an account being sent to an outside collection agency. This may have a negative effect on an individual’s credit status.
Written consent from a legal parent or guardian is required if they do not accompany the minor. The adult accompanying the minor is responsible for full payment at the time of service.
We may call in advance to confirm your appointment. This is only a courtesy, as the responsibility remains with the patient to manage his/her appointments. If you need to cancel an appointment, please give 48 hours notice. If you do not cancel your appointment 48 hours in advance, you will be charged a fee of $25.00 for routine office visit and $50.00 for a comprehensive visit (e.g. Physical Examination).
Forms Filled by Doctor
Work or insurance related forms (such as FMLA) may be filled by the doctor for a fee paid by the patient in advance. $75 for the initial request and $10 for corrections, after the first correction. Please allow sufficient time for this request.
Transfer of Records
If you request the transfer of records to another doctor, there will be no charge. If you request the transfer of records to someone other than another doctor, there will be a $25.00 fee for copy/delivery cost. Payment must accompany the request. Please allow time for this request.