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Patient Office Guide

Patient Appointment Forms

Insurance & Office Policies

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Appointment and Office Policies

The Healthcare Industry is experiencing a dramatic increase in the cost of malpractice insurance in the state of Virginia. At the same time, reimbursement from insurance companies continues to decline. We now find it necessary to institute several changes in our office policies. We appreciate your cooperation and understanding while we endeavor to provide you with the best possible medical care.

  • ARRIVAL TIME:  Please arrive 10 minutes before your scheduled appointment time in order to complete the paperwork necessary for your visit. This will help us to keep to the scheduled appointment times. Updating paperwork is required for every visit to the office.
  • MISSED APPOINTMENTS: $50.00. Missed appointments are appointments cancelled with less than 24 hours notice. Abusive missed appointments may result in your dismissal as a patient. Missed procedure/surgical appointments will incur a $200.00 charge, if cancelled less than one week prior to the scheduled procedure.
  • RESCHEDULING: As a surgical practice, emergency situations arise that my result in the physician being called away to an operating room. As a result, your appointment my need to be rescheduled or the physician may be running late. During these times we appreciate your patience and understanding.
  • MEDICAL RECORDS:  To obtain copies of your medical records you must sign a Medical Release form. There is a $10.00 office fee, plus $0.50/page. These fees, set forth by Virginia State law, must be paid in full before your request can be processed. Please allow two weeks for processing.
  • FORMS, LETTERS, REPORTS:  Disability, workman’s compensation, etc…  The fee for completion of these items is based upon the complexity of the form and time required in its preparation. All fees must be paid in full before the forms can be produced. Please allow at least one week for processing.
  • PRESCRIPTIONS:  If for any reason your prescription for medication, CT Scan, MRI, PET scan, etc., needs to be rewritten there will be a  $10.00 charge for a replacement to be called or faxed to a pharmacy, radiologist, or mailed to you.
  • OUTSTANDING BILLS:  There will be a $5.00 charge per payment period for balances not paid within 30 days.