When you call to schedule your first appointment, we'll ask you for this information:
First, middle and last names Provide the names as they appear on your birth certificate.
Date of birth
Your date of birth is used to identify and verify you, as well as differentiate you from other patients who may have the same name.
Social Security number
We use this number to organize your information. You have the option not to provide this number. If so, another number may be used in its place.
Maiden or previous names
Include name, address and telephone number.
Let us know who to call if an emergency occurs while you are in our care and how to reach them.
We'll need detailed information regarding your insurance plan. Please be sure to bring any insurance documentation, such as plan ID cards, to all of your appointments. Because we often receive insurance plan changes, we may ask you about your insurance at any visit. If your insurance has a co-pay requirement, we will request payment at the time of the visit.
Information you provide us will only be used for providing care to you or your family member.