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New Patient Screening Form
Below you will find our New Patient Screening Form.
This form will take approximately 5-10 minutes to complete.
Upon completing this questionnaire, our Billing Department will do a complimentary benefits verification to ensure that our clinic is able to accept your insurance. For those who are wishing to self pay/cash pay for our services, please indicate as such on this form. From there, our providers will review your completed Screening Form to determine if, based on their current caseloads, they are able to move forward with you as a patient.
Please do not hesitate to reach out with any questions that you have while filling out this form.
Thank you again for your interest in our clinic & we look forward to hearing from you!
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