OFFICE POLICY AND PRIVACY POLICY
OFFICE HOURS
Our office is open Monday thru Friday from 8:00AM to 4:00PM
If an appointment cancellation is necessary, please notify our office at least 24 hours before the scheduled
FEES AND FINANCIAL POLICY
Payment of fees is the direct responsibility of the patient. We collect payment at the time of service. You may pay by cash, check, Visa, or MasterCard, or Discover. If the patient misses more than one appointment without notice of cancellation, the patient will be assessed a Missed Appointment Fee.
INSURANCE BILLING
As a courtesy to you, we will bill your insurance company. When time allows, we will call and check your insurance benefits. This is not a guarantee that you will be covered, as benefits are determined when your insurance processes your claim. Should the insurance deny your claim, we ask that you pay our office directly and contact your insurance company.
SUMMARY OF OUR PRIVACY POLICY
We strongly believe in maintaining your private healthcare information. We do not disclose any non-public information about you to anyone, except as permitted by law, or to process an insurance claim. We maintain physical and procedural safeguards that comply with Federal and State regulations to protect information about you. A complete copy of our privacy policy (4pgs) is available upon request.
I have read and understand the above policies of this office, and I agree with them. I consent to treatment with Dr. Brett J. Hubbard., and/or Dr. Steven L. Gardner., and/or Dr. Maria F. Siri., and/or Dr. Lauren Herschorn. I accept full responsibility for all expenses incurred by, or on the account of the patient. In the event of non-payment, I understand my account will be turned over to a collection company to pursue my balance, and I will pay the cost of collection and legal fees should that be required.
