PATIENT FORMS FOR FIRST VISIT
The following forms will be needed for your first office visit. To save time at check in you can print them out here, fill them in and bring them with you.
Patient Contact and Insurance Form
Financial Policy
Medical History
Health Information Consent
We require all new patients to provide a valid drivers license with a current address and updated insurance card. You must show proof of address with a license or a utility bill etc.
INSURANCE
We provide for the following insurance companies:
- Aetna Indemnity, PPO, HMO
- Aetna World Bank
- Beech St., Healthlink
- Carefirst BCBS PPO and HMO
- Cigna
- Coventry
- Federal BCBS
- First Health
- Guardian (only if through PHCS, or Alliance)
- Greatwest
- GEHA
- Mamsi Life and Health Insurance Company (only)
- M.D.IPA (requires referrals unless preferred)
- Medicare
- Multiplan
- Mutual of Ohama
- NCPPO
- Onenet
- Optimum Choice
- PHCS
- Railroad Medicare
- Tricare (only if it’s secondary insurance coverage)
- Unicare
- United Healthcare (insurance not Medicaid)
