Our team of professionals and staff believe that informed patients are better equipped to make decisions regarding their health and well-being. For your personal use, we have created an extensive patient library covering an array of educational topics, which can be found on the side of each page. Browse through these diagnoses and treatments to learn more about topics of interest to you.
Patient General Forms
- Update Intake Forms
- Financial Policy
- Credit Card on File Agreement (see below for further explanation/FAQs)
- Medical Records Release From Our Practice
- Medical Records Release From Another Provider/Practice
- TeleMedicine Consent Form
Please note there has been a recent change to our Financial Policy (effective 1/13/2020).
We now require a Credit Card to be kept on file for all patients. If you have questions in regards to this policy, please take the time to read the FAQs Regarding the Credit Card on File Agreement found below as to why we have made this change.
Patient Care Instructions Forms
Frequently Asked Questions Regarding the Credit Card on File Agreement
Do I have to leave my credit card information to be a patient at this practice?
Yes. This is our policy and it is a growing trend in the healthcare industry. Insurance reimbursements are declining and there has been a large increase in patient deductibles. These factors are driving offices to either squeeze more patients into shorter periods of time or to stop accepting insurance. We have decided to focus on becoming more efficient in our billing and collections processes instead.
How much and when will money be taken from my account?
The insurance companies on average take approximately 2-4 weeks to process submitted claims. Whatever the allowed amount is, your copay, coinsurance, and deductible are taken into consideration. It simply depends on your individual policy what you may owe. Once the insurance explanation of benefits is received and posted to your account, you will be sent a statement showing your portion. You will have 30 days to send an alternative form of payment if you prefer. If no alternative payment is received, your patient financial responsibility will be processed. Please Note: If your card is denied, a $10 late fee will be added each month following, until the balance is paid, as noted in our financial policy.
How do you safeguard the credit information you keep on file?
We use the same methods to guard your credit card information as we do for your medical information. The card information is securely protected by the credit card processing component of our HIPAA compliant practice management system and credit card manager. This system stores the card information for future transactions using the same sort of technology that any online retailer would. We can’t see the card number – only the last four numbers, giving us no way to use the card outside of the billing system. There is no way to export the card information out of our system.
What are the benefits?
It saves you time and eliminates the need to write checks, buy stamps or worry about delays in the mail. It also drives our administrative costs down because our staff sends out fewer statements and spends less time taking credit card information over the phone or entering it from the billing slips sent in the mail, which are less secure methods than us storing the information. The extra time the staff has can now be spent on directly helping the patients, either over the phone, with insurance claims or in person.
I always pay my bills on time. Why do I have to do this?
The entire billing process is time consuming and wasteful, and the few patients that we do have to send to a collection agency end up costing a lot of money. Reducing unnecessary costs are essential to allowing us to continue to be an in-network provider with most insurance companies. Nothing is changing about how much you end up paying.
What if there is a payment discrepancy or I have other payment questions?
Please contact our billing department directly to settle payment discrepancies or for other payment questions. This policy in no way compromises your ability to dispute a charge or questions your insurance company’s explanation of benefits.
Will I still receive a paper bill by mail?
Yes. You will receive one bill which will show what will be charged to your card in 30 days. If you prefer to pay by an alternative method, you may do so during that period. If you do not wish to make any payment method changes, just hold onto the statement for your records and your card will be charged.
As always, you can contact our office to answer any questions or concerns.
Although less common, there are a few skin conditions related to pregnancy:
PUPPP (Pruritic Uticarial Papules and Plaques of Pregnancy)
This condition occurs in roughly one percent of pregnant women. It is characterized by itchy red bumps and hive-like rashes that usually appear on the belly or around stretch marks. The rash may spread to the arms, legs, breasts or buttocks. PUPPP usually begins in the third trimester of pregnancy. It is harmless, but the itchiness can be severe. There is no known cause for the condition. Treatment typically includes the use of topical ointments, antihistamines and, in more severe cases, oral steroids to help alleviate the itch. PUPPP usually disappears a few days after the baby's birth.
Prurigo of Pregnancy (Papular Eruptions of Pregnancy)
A rare skin condition that can occur anywhere on the body. Prurigo looks like a collection of bug bites. Its onset is usually not before the third trimester and it typically lasts up to three months after delivery. The condition is harmless to mother and baby. Like PUPPP, it is generally treated with topical ointments, oral medications, antihistamines or steroids.
Pemphigold Gestationis (Herpes Gestationis)
This extremely rare condition starts as a hive-like rash, which turns into large blistering lesions. It usually begins on the abdomen and spreads to the mother's arms and legs. It causes severe itchiness. It typically begins in either the second or third trimester. It may also come and go intermittently throughout a pregnancy. Pemphigold gestationis is associated with an increased risk for pre-term delivery and fetal health issues. If you suspect you may have this condition, seek immediate medical attention.