Our Policies
Due to rising perscription processing and physician overhead costs, the following policies have
been enacted. We apologize for any inconvenience and thank you for your cooperation in following
our care policies.
Cancellation Policy
Patients are required to call and cancel appointment 24 hours prior to scheduled
appointment. Failure to call and cancel 24 hours in advance will result in a charge of $20.
Missing 3 appointments without calling to cancel will result in dismissal from practice.
Rx (Prescriptions refills)
Patients who are on chronic medications are expected to keep track of
when a refill is needed. All refills are to be taken care of at appointment times. It is the patient's
responsibility to make sure you have enough medicines until your next scheduled appointment. There
is a $10.00 charge for calling or faxing a prescription into your pharmacy.
Controlled Substances
Examples of controlled substances include; Vicoden™, Percocet™, Oxycontin™, Xanax™,
Valium™, Talwin™, Tylenol™ with codeine and Fiorcet™. You are REQUIRED to make an appointment for refills.
No refills will be called into Pharmacy. Narcotic contract for controlled substances will be implemented.
Failure to follow contract will result in dismissal from practice.
Co-Payment Policy
Co-payments are due at the time of check in for those patients with an applicable co-payment.
Primary Care Physician Assignments
If you are assigned to a primary care physician by your insurance
company, and the name of another physician appears on your card, it is your responsibility to call your
insurance company and change it prior to your office visit. If you do not change prior to visit you will
be held financially responsible for the office visit.
Referrals
If your insurance company requires a referral for a specialist visit, it is your responsibility
to request these at least five (5) business days in advance. We need the name, address and phone number
of the specialist, as well as the reason for the referral, and date of appointment. Retroactive referrals
are not permitted by the insurance company, in which case you will be responsible for the specialist
office visit fee.
Forms
All forms (disability, etc.) that have to be filled out by the physician will have a charge of $10.