We wish to make your initial office visit and all subsequent visits as easy as possible. In the past, most people would go to a physician’s office and be confronted with a myriad of forms before they even saw a physician. In order for you not to waste your time in our offices, we have designed a webpage that allows you to enter data into our specially designed forms in a private and secure environment. Take your time and read the materials in the comfort of your own home or office.
The initial documents are for the new patient, but are also a way for you to communicate a change of insurance or address if you are an established patient. Remember, the following forms may help you manage your medical care better. The questions asked may appear to be extensive. Please don’t think that we wish to overwhelm you. We are merely complying with medical law established locally and nationally.
Our job is to provide you with outstanding medical care and service. If you have any questions, please do not hesitate to inquire.
Important Security Instruction For Online Forms
These forms are protected for your safety and security. Please fill them out on your desktop computer with a direct connection to the internet. Many wireless networks do not have the level of security needed to satisfy HIPAA compliance. Microsoft Windows and Apple IOS for desktops each will allow you to fill out all forms in a safe and secure manner. The hosting site of our online forms has also developed an IOS (Apple) mobile app that can be downloaded and used to complete these forms. You may encounter difficulty if you attempt to use an android mobile device. We hope you find utilizing these forms gives you the added convenience of being able provide the necessary information at home or work. You safety and security will always be a major concern!
Forms For The New Patient
|Patient Registration – Adult||This form needs to be filled out by all new patients over age 18.|
|Patient Registration – Minor||This form needs to be filled out for all new patients below the age of 18|
|Privacy Practice and Acknowledgement||This form explains our privacy practices. We take your privacy very seriously. Please review and sign.|
|Financial and Billing Policy||This form is very informative. It explains which types of insurances we accept. It also discusses insurance company benefits and policies and how they pertain to our offices. Please review and sign.|
|Preauthorization and Denial of Services||This form explains how our offices handle preauthorization. It also explains that some services may be denied by your insurance company. Please review and sign.|
|Streamlining of Payment||This form explains how we are attempting to streamline payment with credit card information. Please review and sign.|
Forms For Medicare Patients
|Medicare and annual physical examinations ABN||Medicare does not cover some preventative services. If you have Medicare and request a service such as an annual physical examination, this form explains Medicare policies and requires your signature.|
|Medicare and Pre-operative evaluations ABN||Medicare does not cover some examinations. If you have Medicare and request such a service such as a preoperative examination, this form explains Medicare policies and requires your signature.|
Forms For Your Convenience
|Release of medical records||This form was created for your convenience if you wish to ask your previous doctor to send medical records to Dr. Wilson. Simply fill this out and present it to your previous doctor’s offices.|
Forms For Our Concierge Patients
|Concierge Agreement||Welcome to our concierge services. We are appreciative that you have chosen to take advantage of this remarkable service. This is a contract between you and our offices to provide you the most exemplary care we know of.|
|Concierge Thank You||We wish to thank you for becoming a concierge member. We are sure you will be pleased with your choice. This letter is a brief thank you and information letter for our new members.|