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Patient Information

Appointments

New Patients: If you need to cancel, please notify our office 24 hours in advance.  There is a $50.00 charge for untimely cancellation or not showing.  Also, in fairness to our other patients, if you arrive more than 5 minutes late you may be required to reschedule your appointment.
Established: If you need to cancel, please notify our office 24 hours in advance. Also, in fairness to our other patients, if you arrive more than 5 minutes late you may be required to reschedule your appointment.
 

Referrals

Unless it’s an emergency, referral requests require 24 hours notice and are subject to the terms of your insurance coverage. 


Prescription Refill line:

Please call 315-786-3077 for your prescription refill and sample request needs.  It is available Monday - Friday from 9am - 4pm.  For assistance after hours, weekends & holidays please call our main number at 315-782-2141 and the physician on call will assist you. 

Although we try to process most orders the same day, we do ask that you give us 24 hours notice when possible.  To process your request you will need to provide the following information: 

 

  • patient name
  • phone number
  • date of birth
  • name of medication, dosage, and quantity needed. 
Also, please advise if you want your prescription mailed, called into your pharmacy, or if you will be picking it up at the office.  Please be sure to leave the name and location of your current pharmacy.  


Dear New Patient:
 
Please assist us by following the instructions listed below:

1. As required by law, we must validate the identification of all patients establishing care with our practice.   Please bring photo identification (ex: Drivers License, Passport, Military ID, School ID etc…) with you to this appointment.  A parent or legal guardian must accompany any patient under the age of 18.  Proof of guardianship must be provided prior to services being rendered. 

2. Your appointment is an hour long appointment.  Please call 782-2141 and confirm the above date and time upon receipt of this notice.  We require 24-hours notice should you need to cancel this appointment.  There is a $50.00 charge for untimely cancellation or not showing.  Please note that arriving more than 5 minutes late may result in the rescheduling of your appointment. 

3. Please complete the enclosed patient registration form. Bring this form along with your insurance card(s) to your appointment.  You will be asked to electronically sign our billing/ financial statement upon arrival at our office.  Our Financial statement is available upon request.  

4. We are requesting blood be drawn in our lab the morning of your appointment.  Please nothing to eat or drink 12 hours prior to having your blood work drawn, except for a small amount of water.  You can take your medications.  You can have your blood drawn anytime after 7:45am.  Our office opens at 7:30am.

5. Bring ALL medication bottles or a complete list of all medications, including vitamins and/or any herbal supplements that you are currently taking.  Please do not apply body lotions. Ladies:  No panty hose please

6. Please bring with you or have forwarded your prior medical records.  A medical release is enclosed for your convenience.

7. Co-payments, co-insurance and deductibles are due at time of service.  For your convenience we accept VISA, MasterCard, ATM/Debit cards as well as cash and personal checks.  There is a $25.00 fee on any returned checks.

8. College, employment, yearly and sport physicals may or may not be covered under your health plan.  You will need to check with your insurance carrier prior to your appointment and determine coverage.  All non-covered services will be due at the time of service.

 
Patient Conduct Attestation
Patient Registration Form
Patient Portal Brochures
RHIO Letter & Consent Form
Patient Portal User Agreement
Welcome to Our Office
Financial Policy & Consent to Treatment
MOLST FORM (End of Life Planning)
New Patient Registration Packet
MEDICAL RELEASE
Insurance Disclosure Notice

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