Thank you for scheduling your appointment. I look forward to assisting you with your health care needs.

To better serve you, please have the required intake paperwork completed prior to your appointment. Please check in 5 to 10 minutes early. If you know you are going to be late, please let me know as soon as possible.

Required Paperwork

• Health History and Health Insurance
• Consent, Policies, and Privacy Form
• COVID Informed Consent to Treat

Paperwork instructions:

• Print and fill out the attached paperwork to the best of your ability.
• Bring the paperwork to your appointment.
• If you do not have access to a printer, please come in 15 minutes prior to your appointment.
• If you have any questions with the paperwork, please do not hesitate to contact me.

As a courtesy, I can verify your benefits and bill your insurance on your behalf; please bring your health insurance card with you to the appointment.  If this is an auto claim please bring your claim number and the name of the adjuster.

If there are any discrepancies with your benefits, I will contact you as soon as possible. Please note all quotes of benefits are not a guarantee of payments. Payments such as co-pay, co-insurance, and annual deductible are due at the time of service.

Please bring with you the following:

• Photo ID
• Insurance card

I have set this time aside for you. If you are unable to keep this appointment, please let me know 24 hours from the time of your scheduled appointment. My cancellation policy is 24 hours minimum from the time of your appointment. Less than 24 hours cancellation is $50 charge. Appointment no show is $90 charge.