Below you will find our new patient paperwork. This paperwork must be completed for all new patients. We have also included a list of accepted insurances. Please call your insurance provider to verify that we are a current provider and to what extent our services are covered under your benefit plan.
NEW PATIENT FORMS (PATIENT REGISTRATION PACKAGE)
Below you will find our new patient registration package. Please download, print, and complete all the forms in this packagee prior to your first visit. You may bring the completed forms with you to your initial visit or mail or FAX them prior to this visit. Having this patient registration package completed by your first visit will allow us to better serve you and allow you to be seen in a timely manner. Thank you for putting your trust in us and we look forward to seeing you!
Note! When clicking the patient registration package link below, the PDF may open within your browser window. It is important you download the PDF form to your computer BEFORE filling in the fields. This is an important step!
NEW PATIENT REGISTRATION PACKAGE TO FILL OUT AND RETURN BEFORE YOUR FIRST VISIT
OTHER INFORMATIONAL FORMS
PATIENT TELEVISIT INSTRUCTIONS
INSURANCES & PAYMENT OPTIONS
We accept most insurance plans. We have listed some of our common carriers below. This is not a complete list. Please contact your insurance provider or visit their website to verify we are an active participant in your plan. We accept Visa, Mastercard, Discover and American Express. Please contact us regarding private pay rates. We are happy to make payment arrangements for patients with outstanding balances or those who are private pay (without health insurance).
Blue Cross/ Blue Shield
Amish Community Aide
Cleveland Clinic Employees
The Health Plan
Ohio Health Plan
We are now accepting Care Credit! Care credit cannot be processed on our payment website, so please call our office to make a payment with your active Care Credit Card. We can also assist you in applying for Care Credit in our office and discuss promotional payment plans that are available. Call today for more information.