New Patient Orientation Packet
you are a new patient, download our New Patient Orientation Packet*,
please complete it before your visit, and bring it with you, this will
help us serve you better and allow you time to read and answer all the questions necessary to provide you superior care.
APPOINTMENTS: All patients will receive access to appropriate medical care within a reasonable length of time. Appointments will be made according to type.
EMERGENCIES: Will be seen in our office by your primary
doctor or a nurse practitioner unless physician feels hospital ER more
appropriate (i.e. severe trauma, severe bleeding, seizures, chest pain,
URGENT: Within 24 hours (i.e., high fever, animal
bites, flu, severe pain, etc.) Please call as early in the day as
possible or as soon as symptoms begin to expedite a walk-in appointment.
Depending on the type of appointment you need (regular follow-up,
consultations, Pap smears, physicals), you may be scheduled within two
weeks to three months of your call. Please provide us with information
about whether your insurance pays for well visits or preventive care at time of service.
WALK-INS: We strongly urge all patients to call the office first. If all physicians are booked and it is not an emergency, you may be asked to schedule an appointment.
AFTER HOURS: We have a physician on call 24 hours a day to provide emergency and urgent medical needs.
PAYMENTS: We accept VISA, MasterCard, American Express, Discover Card, cash and checks.
Please bring a list or actual bottles of medication you are taking
with you to each visit. You should ask for refills, if needed, at each
No prescription refills can be done on the weekends, holidays, or after hours unless it is an emergency.
Family Practice's refill hotline allows you to leave your request for
routine refills without waiting. Please allow 24 hours for them to be
If you are over-due for a follow-up visit, refills
will be given to provide enough medication to last you until your
scheduled appointment to be seen.
Patient Name and Date of BirthName of PhysicianName of Drug and how frequentPharmacy Name with telephone numberA phone number (i.e. home number, cell phone, work phone, etc.) where you can be reached between the hours of 8:30am and 4:30pmDO NOT LEAVE PAGER NUMBERS
When requesting a refill you must provide us with the following information:
Our office will facilitate a referral to another physician if needed.
Please allow 3 to 5 days to obtain a referral (unless it is an
emergency). The patient may retrieve a voicemail message with
appointment date and time,
via the Client Tell (1-866-859-8151). Your insurance company requires
that you be seen for the illness/condition before a referral can be
TEST RESULTS: Will be called the
Client Tell (1-866-859-8151) or called to the patient within 10-14 days.
Please allow 7-10 days before you call and request results. If a
physician outside our group orders a test on you, you will need to call
that office for the results.
FEES AND INSURANCE:
One of the goals of our practice is to keep the cost of our medical
care as low as possible. In order to do this we ask that you adhere to
Co-pays and deductibles should be made the day of the visit.
Uninsured patients should pay full payment with each visit.
Present your health insurance card at each visit and update your records whenever a charge occurs. If no changes occur, you will be requested to update annually.
a courtesy to you, we will bill your insurance. We will assist you in
anyway we can in getting benefits to which you are entitled, however,
the ultimate responsibility for payment and providing accurate information about your particular policy is yours.
special financial arrangements need to be made, you should contact our
office manager. If your account balance is over 90 days and no payment
arrangements have been made, you may be turned over to our collection
Click here for more information about Summit Medical Group's Insurance/Billing