Office Policies. E-mail data may be unsecured and result in health information being distributed to unknown third parties for which EFM is not responsible. Use of the secured patient portal is the preferred route of communication for routine matters. Phone call is the preferred route of communication for urgent matters. EFM does not provide emergency care. There may be times when Dr. Black is unavailable. If a health matter is urgent I agree to seek care at an urgent care or emergency room. The preferred urgent care for Empower Family Medicine is Urgent Care at Druid Hills 0000 X Xxxxx Xxxxx Xx XX Xxxxx X, Xxxxxxx, XX 00000. All prescription refills for chronic medications should be requested at office visits. Routine refills will not be issued by phone, fax or call. Xxxxxxx Xxxxx M.D. This agreement ("Agreement") is entered into by and between Empower Family Medicine, LLC, a Georgia professional corporation, owned and operated by Dr. Xxxxxxx Xxxxx, MD, (the "Physician"), whose principal medical office is located at 000X Xxxxxxx Xxx Xxxxx 000 Xxxxxxx, XX 00000, and , a beneficiary enrolled in Medicare Part B ("Beneficiary"), who resides at .
Office Policies a. Appointments and Cancellations. Appointments will ordinarily be 50 minutes in duration, once per week at a time we agree on, although some sessions may be more or less frequent as needed. The time scheduled for your appointment is assigned to you and you alone. If you need to cancel or reschedule a session, I ask that you provide me with 48 hours notice (2 business days). If you miss a session without canceling, or cancel with less than 48 hour notice (2 business days), my policy is to collect the amount of the full session. If there is an emergency or illness, please contact me so we can discuss it. In addition, you are responsible for coming to your session on time. If you are late, your appointment will still need to end on time and you will still be charged the full cost of the session. If I am running late, I will do my best to give you a full session. If I am unable to do so, then a prorated amount of my hourly rate of $115 will be charged. _____ I understand that sessions must be cancelled 2 business days (48 hours) in advance or there will be a charge of $115. (Please initial.)
Office Policies. I / We hereby authorize mutual exchange of information between providers of Statesboro Pediatric Dentistry 000 X. Xxxxx Street, Statesboro, Ga. 30461. And any other medical or dental provider (except: ) for our child necessary to provide appropriate dental care. • The following information from his/her records can be obtained: X-Rays, Medical and Dental records Indicate nature or extent ofinformation: • The above information is to bereleased for the following purpose only: Dental Treatment and update Medical/Dental • I understand that I may revoke this authorization at any time, except to the extent that action has been taken based on this authorization before it is revoked.
Office Policies. It is usual and customary for the fee to be paid at the beginning of each counseling session. Other arrangements will have to be made in advance. Sessions start on the hour and are usually held once a week at first to ensure the greatest change possible. All requests for copies of your file or amendments are to be made in writing.
Office Policies. It is usual and customary for the fee to be paid at the beginning of each counseling session. Other arrangements will have to be made in advance. Sessions are usually held once a week at first to ensure the greatest change possible. There is a $25 NSF for all checks returned. All requests for copies of your file or amendments are to be made in writing.
Office Policies. Xx. XxXxxxxxx is committed to providing a welcoming environment for her patients. Your time is valuable as is that of all the families served by this practice. The following policies are designed to improve everyone’s patient experience: Please arrive on time for your visit. Other patients have appointments after yours and thus families that arrive more than 10 minutes late may be asked to reschedule the visit. If you cannot make the appointment, please call more than ONE office business day ahead of time to reschedule. Last minute cancellations and no-shows may be charged a fee. Reminder calls are made as a courtesy only. It is your responsibility to know the time and date of your appointment. Tests (labs and X rays) may be requested prior to the appointment. Please ensure you have the test done on time so the results can be reviewed with you at your upcoming appointment. The due date is indicated on your visit summary and test order sheet. You may be asked to reschedule if the results are not available in time or if the tests have not been obtained. Patients who miss more than 3 appointments may be asked to continue their care with another practice. Please have your medication list ready for review during office visits. Please contact your pharmacy for all prescription refill requests. Please allow at least 2-3 business days for processing. Prescription refills require regular office visits. To ensure you or your child’s safety, a regular evaluation of the condition and medication interactions is required. If you are transferring care from another provider or center, please ensure that all previous clinic notes have been sent BEFORE the scheduled appointment.
Office Policies. Appointments
Office Policies. Appointments are specific times reserved for you. Sessions typically run fifty (50) minutes in length. Service Fee Agreement:
Office Policies. The appointment times are reserved exclusively for you. Please consider your appointment card as your confirmation. We understand that conflicts in schedules sometimes arise. If that is the case, we ask that you give us a 48 business hour notice so we can use that valuable time for patients who may be in need. We hope that you will help us in this issue so we can better serve you and our other patients. A
Office Policies. In order for An Optimal You to provide proper treatment, patients must be responsible for setting up follow up visits to continue their treatment plan. Follow up visits on hormone replacement therapy, anti-aging services, or other medically supervised treatment plans are required on a regular basis as advised by the treating provider based on your medical needs. It is the patient’s responsibility to know what type of appointment he/she is due for. If unsure of what type of appointment is needed is it best to leave a detailed message of your symptoms for the provider that is treating you to get a recommendation of what type of appointment you may need. Failure to schedule the appropriate appointment type will result in a follow up consultation fee (i.e. scheduling a re-pellet procedure but seeing the provider for an office visit instead will incur an office visit charge—it is not a free visit). Blood work is advised to be done prior to most follow up appointments. Failure to get bloodwork done does not justify the cancellation of your appointment with less than 2 business day’s notice. Insertion of hormone pellets are every 3 to 6 months. An Optimal You will usually combine your follow up visit with your re-pellet procedure. Pellet boosts are done at no charge 4 to 5 weeks after insertion of pellets if the patient is still symptomatic (5 weeks or longer past the pellet insertion will incur a charge). It is your responsibility to communicate to our office in a timely manner if your symptoms persist at 4 weeks. Follow up visits for patients on creams, capsules, or injections are typically every 3 to 6 months depending on your medical condition. Any Bio-Identical hormone prescriptions (excluding pellets) will be sent directly to the compounding pharmacy and these are paid by you directly to the pharmacy. For prescription refills, we ask that you contact the pharmacy directly a week in advance since compounded medications take time. Contact our office if you run into any difficulties. Single IV therapy treatments are the responsibility of the patient at the time of service. Patients are responsible for the full price of the IV therapy treatment whether the treatment is fully or successfully administered. Single IV therapy treatments that are offered in IV packages will not count towards the IV package series if the IV package is not purchased within the same day of receiving the single IV therapy treatment. IVs that are offered within IV combo packages cannot b...
