New Patient Forms
Medical Records Release Form
This form is needed to release medical records. New patients do not need to fill this out unless you want your records to be sent to another physician.
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Contact Us for Cosmetic and Product Specials, Practice Updates
Cancellation & No Show Fees
Please note, there is a $35 no show and cancellation fee if your appointment is not cancelled within 24 hours of your appointment.
For billing questions, please contact our contracted billing company MEDCOMM at 1-614-553-0997. Please have your patient account number handy or include it in your email so we can assist you better.
Insurance and Payments
Co-payments and deductibles are due at the time of your visit. Per federal law, you must have your insurance card and photo ID at each visit. If you have questions, please call (614) 898-7546 to speak with a billing associate or manager prior to your appointment.
You are responsible for all costs not covered by insurance. For out-of-pocket expenses, including deductibles, co-insurance and co-payments, we accept Visa, MasterCard and Discover credit cards, as well as personal checks and cash.
Plans we accept include but are not limited too:
AARP MEDICARE COMPLETE
AETNA TRINITY HEALTH
BLUE CROSS BLUE SHIELD
BUSINESS ADMIN CONSULTANTS
CIGNA/GREAT WEST CIGNA
KLAIS & CO
MEDICAL MUTUAL HMO
MEDIGOLD PPO & HMO
MUTUAL OF OMAHA
OPTIMA HEALTH/OHIO HEALTHY
PRINCIPAL MUTUAL LIFE
TRICARE/TRICARE FOR LIFE
UHC MEDICARE COMPLETE
Plans that require a referral:
UHC MEDICARE COMPLETE HMO
We are not providers for any Medicaid or Dual Advantage plans.
If your plan requires a referral to see a specialist, please ensure one is in place prior to your scheduled appointment; otherwise, we may need to reschedule.
If you do not see your insurance listed here, please contact our office and/or your insurance company to find out if we are in-network for your plan