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Patient
Information

Patient Information

What to Bring to the Appointment

  • Patient's insurance card
  • Physician referral forms, if required by insurance
  • List of prescriptions and/or over-the-counter medications, including dose and frequency
  • Information about the patient's medical and surgical history
  • Recent x-rays or relevant records

Patient Forms

Insurance and Payment Information

Insurance Information

Payment for office examinations and procedures is expected at the time of service. A receipt will be furnished to enable you to send it directly to your insurance company for reimbursement. For your convenience, we also accept Visa and MasterCard.

Our physicians are providers for various managed health care plans. Please refer to your provider directory or contact your health plan to verify our physician as a provider of a particular plan. In addition, they will be able to assist you as to your responsibility in seeking care from our physicians, as well as benefit information, financial responsibility and authorizations. Insurance copayments, coinsurance amounts, deductible portion and non-covered charges will be collected at the time of service.

Our physicians are participating providers with Medicare. Patients will be responsible for payment of deductible, coinsurance and non-covered charges at the time of service.

As a courtesy to our hospital patients, our office will file all primary and secondary insurance claims. If a delay in payment occurs, please contact your insurance company.

It is extremely important to furnish our office with your insurance information at your initial visit. If coverage has changed, please notify our staff upon return visits.

Payment Information

Payment for services rendered is the responsibility of the patient, regardless of insurance coverage. Depending upon the individual contract that exists between the patient and insurance carrier. Reimbursement may be subject to policy deductibles and/or percentage of allowable charges. We are happy to assist you with information your insurance company may require to process your claim.

Billing questions may be answered between 9:00 a.m. and 4:00 p.m. Monday through Friday by calling our office at 813.872.1548.

Hospital Affiliations

We are pleased to be affiliated with the following hospitals:

Languages Spoken

English, Spanish, Afrikaans

Privacy Practices

Our Notice of Privacy Practices describes how we may use and disclose your protected health information. A copy is given to all new patients and is available upon request.