Our Family Care Medical Practice strives to make your visit as smooth and pleasant as possible.  As a new patient, you will be asked to complete some forms to help our Providers and Staff to ensure you have the best care.  There are also consent forms, HIPAA information, Annual Administration Fee Notification, and Patient rights that are important for you and your family’s overall healthcare management. For your convenience, we have provided these forms online to download in PDF format so that you may fill out prior to your visit. This will let you focus on this important information and expedite your initial check in time. 

Patient Information
Adobe Acrobat Reader is required to read the patient forms

 

**FOR MEDICARE PATIENTS, there are additional forms and questionnaires that will help prepare you for the IPPE (Initial Preventative Physical Examination) "Welcome to Medicare" Physical Exam and your Annual Wellness Exam. For more information on Medicare Physical Exams including what to expect and coverage go to Welcome to Medicare Website.

Forms and Education Handouts for Medicare Exams

Cancellation of Appointment Policy

Please notify our office immediately if you are unable to make your appointment. This will allow us time to give that appointment to a patient in need. Unless there is a valid emergency the day of your appointment, it is highly recommended to call our office at least 24 hours prior to your scheduled appointment date to avoid a fee of up to $75.

Health Insurance/Payment

We gladly accept most insurance plans such as common major PPO plans including BCBS, AFMC, HealthNet, UHC, First Health, Coventry, CCN, PHCS, Beech Street, MultiPlan, and Medicare. We may accept other plans not mentioned here. We are more than happy to work with patients with health savings accounts as well as private pay patients. Please call our office at 602-482-6100 prior to your visit if you have any questions about your coverage.

Payment for co-pays and deductibles will be due at your office visit. Should you ask us to bill your co-pay, a service charge will be added.  Payment plans are available if arrangements have been made with our billing office prior to you appointment. We gladly accept cash, debit cards, VISA, MC, DISC, AMEX. Please no checks.

Annual Administration Fee (implemented 2013)

In order to continue practicing timely,  comprehensive medicine and cover the cost of a growing multitude of non-covered and excluded clerical and administrative expenses, an annual administration fee is being charged.  We regret having to implement this fee but we are no longer able to absorb these costs due to continued decreasing payments from Medicare and health insurance companies.  The annual charge for age 25 and older will be $60 and age 5 to 22 will be $25.  Please click on the following link for our letter on the Annual Administration Fee.

Lab Results

Annual Physicals and other routine visits may involve labs that our providers will recommend to help diagnose your symptoms, monitor chronic disease and medication management, or screen for disease prevention.  Most routine labs are done right here at our Family Care Medical Practice.  Please allow at least 72 hours before requesting your results.  In some cases, certain special labs will be sent out to outside testing facilities which may take up to two weeks.  You will find a Patient Contact form in our Patient Information section to fill out and update the best contact number to reach you so that we may relay your lab results. 

Prescription Refills

Please have your pharmacy fax a refill request at least one week before you run out of your medications.  If you are on long-term medication for chronic diseases you might be requested to make a follow up appointment prior to refilling your medications.  It is highly encouraged that you are evaluated by one of our providers every 3 to 6 months (depending on control of your condition) so that you have the best overall outcome, care, and disease management. 

Special Form Requests

Forms that are requested to be filled out by one of our providers may involve a flat rate  Administrative Fee if not included in your Annual Administration Fee. Common forms include wellness/school/sports physical forms, DOT forms, assisted living/home healthcare forms, Nursing School/EMT forms, Jury Duty excuse letters, and others. Please call our office at 602-482-6100 for questions about your request.

For Frequently Asked Questions, please click on link FAQs.


Thank you for your cooperation and we look forward to caring for you and your family!

Practice Policies

Call 602-482-6100 to schedule appointment!