We would like to take this time to welcome you to our office. We will do all we can to make your visit a pleasant one.
We have enclosed several forms, which we ask you to complete in full. Once you have filled out all information, please bring them all to your scheduled appointment.
INSURANCE: Please bring in your insurance cards. Copies will be made and kept in your chart which allows for prompt and accurate processing of your claim. As a courtesy, we will be happy to submit all claims to your insurer. Should your carrier refuse payment, you will be required to pay for all unpaid claims. All deductibles are also the sole responsibility of the patient. Payment in full must be made within 30 days of the billing or a surcharge of $29.00 may be implemented unless other satisfactory arrangements are made. We do offer payment plans.
COPAYS: All copays are required prior to seeing the doctor, which is dictated by your insurance company per your contractual agreement with your insurance carrier.
MANAGED CARE: If your insurance requires a referral from your Primary Care Physician, that is your responsibility. We do not obtain referrals for you.
HISTORY FORMS: We do not treat a toe, a nail, or a foot. We treat people. Please fill out all medical information. Please note the highlighted areas and read carefully. DO NOT WRITE IN yes or no under medical history, check only those which apply. Please check any yes or no responses. Family history, social history, and past surgeries are required information. PLEASE BRING IN A WRITTEN LIST OF ALL MEDICATIONS, PRESCRIPTIONS, OR OVER-THE-COUNTER. Include the dosage, amount per day, and the reason you take it.
X-RAYS: If applicable, please bring in any x-rays and written reports you may have at the time of your visit that pertains to your problem.
This letter has been created to alleviate any potential misunderstandings or miscommunications. Our office is always open to you for any questions or concerns you may have. We hope that your visit with us is a pleasant one. On behalf of Dr. Olson, Dr. Tomassi, Dr. Hess, Dr. Pokabla, and staff, we sincerely thank you.