Bone and Joint Surgerons Forms
New Patient
(This file contains all of the forms needed on your first visit)
Self Referral
Physician Referral
Medical History
Financial Agreement
Privacy Policy
Medical Release

Appointments

Office hours are 8:30am to 4:30pm Monday thru Friday.

The office is closed on weekends and most holidays.

Most insurance plans require you to be referred to a surgical specialist by your primary care provider. Please check with your insurance carrier for specific details. If this is the case, please have your PCP fill out the Physician Referral Form.

If your plan does not require a physician referral you may call the office to schedule or download the Self Referral Form and fax / mail it to us.

Please arrive 10-15 minutes early for your appointment to allow time to complete paperwork.

Things to bring to your appointment:

Driver's license or State ID
Insurance or Workers Comp Cards
Copies of pertinent operation records, medical records, x-rays, MRIs, CT scans
Medications list
Please wear comfortable, loose fitting clothes so that the body part you are having trouble with can be easily examined and/or X-rayed. For example, please bring shorts if you are being seen for a knee problem.

To cancel an appointment:

Please call our office at least 24 hours ahead so that your appointment time can be allocated to another patient who is seeking treatment.

Billing

Please bring all insurance cards to each appointment. We will ask you to update your personal/insurance information every six months. However, it is your responsibility to notify us of any changes when they occur.

Co-payments, deductibles and outstanding balances are due at the time of service. We accept Cash, Visa, Mastercard and Discover.

Telephone Calls

Our staff has been trained to handle all incoming calls. This allows doctors and nurses to attend to our office patients with a minimum of interruptions. The nurses and medical assistants return phone calls promptly throughout the day.

Prescriptions

Please call our office during regular business hours for all prescriptions refills. You will need to provide us with the following:

Your Name
Date of Birth
Name of the medication
Dosage
Pharmacy Name and Phone Number
It is our policy not to refill medication after hours or on weekends and holidays.

Insurance Forms

Please fill out all patient related information and signatures prior to submitting forms for our completion. Please all 5 business days for form completion. The following fee schedule applies:


Workers Compensation Forms - Free
Insurance Pre-Authorization - Free
Physical Therapy Progress Notes - Free
Return to Work/School/Play - Free
Family Medical Leave Act (FMLA) - $20
Short Term Disability Forms - $20

Medical Records

Due to HIPPA guidelines, we are not allowed to discuss or release medical records without first obtaining a written request from the patient or legal guardian/power of attorney. There is a $10 fee for each copy request.


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All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions.
You should seek prompt medical care for any specific health issues and consult your physician.


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