Please arrive early so that we can complete your initial paperwork. Also, please bring the following:
Your medical insurance card(s)
Your driver’s license or other picture ID
A list of all of your current medications
Any diagnostic reports (MRI, CT, EMG, etc.)
Any physician records pertinent to your condition
We look forward to meeting you and assisting you on the road to effectively managing your pain condition.
We do not see any walk-in patients.
As a courtesy to the physicians, staff and other patients, we ask that you DO NOT bring other family members experiencing pain problems to your appointment to be seen unless they also have a scheduled appointment. We will be more than happy to schedule an appointment for any family members at a later time.
This office makes every effort to contact you for a reminder call. Please remember that this is a courtesy and is not required. It is your responsibility to be here on time for your appointments.
THIS OFFICE NOW REQUIRES 24-HOUR NOTICE FOR ALL CANCELLATIONS. Our policy is to charge for those who miss or cancel with less than 24-hour notice after the 2nd missed or cancelled visit.
Prescriptions for Narcotics & Medication Appointments
Patients who receive Narcotic Medications are required to have a signed Controlled Substance Agreement in their Medical Record. Prescriptions for narcotics will not be released without completing this agreement. NO PRESCRIPTIONS WILL BE CALLED IN AFTER 12:00 P.M. ON FRIDAY'S.
Patients are required to see the medical assistant for monthly medication prescription refills and they are required to see the physician on a quarterly basis.
IF YOU NEED TO CHANGE YOUR MEDICATION(S) YOU WILL NEED AN APPOINTMENT WITH THE PHYSICIAN, THE MEDICAL ASSISTANT IS NOT ABLE TO PERFORM THIS FUNCTION. PLEASE CALL AND RESCHEDULE YOUR APPOINTMENT TO SEE THE PHYSICIAN, YOU WILL END UP BEING RESCHEDULED TO DO THAT AS NO CHANGES CAN OCCUR DURING YOUR APPOINTMENT WITH THE MEDICAL ASSISTANT.
It is imperative that our office be provided with current information on you. We must be able to contact you. Please keep us updated of new addresses, phone numbers, place of business and insurance information.
Medical Record Requests
All medical record requests require a signed written release of information present in the patient chart. If a release is not signed the patient will be required to sign a release before processing begins. A copy of our release can be mailed or faxed. All requests for records will be processed within 15 business days. A processing fee of $1.00 for the first page and $.50 per page thereafter, plus any applicable postage will apply (pursuant to Florida Statute, Chapter 395). Payment is due prior to the release of records.
The following forms can be downloaded to your computer and printed at home. Or fill out the interactive PDF form, save it and email it to us at firstname.lastname@example.org. By filling out these forms ahead of time, you will save a significant amount of time during your initial visit.
*All forms provided in web-standard PDF format, easily opened using the standard Adobe Acrobat Reader. If you do not have the Adobe Reader, you can download it for free by clicking here
or on the Get Adobe Reader icon.
Disability, Driving and Other Forms
If you have a disability, financial or similar forms that needs to be completed by our office, please remember that we need at least 7 – 10 days for processing and processing fees do apply. The fee for these forms is $10.00 per page with a maximum fee of $30.00.
Insurance and Payment Information
We are dedicated to providing you with the best possible care and service. We regard your understanding of our financial policies as an essential element of your care and treatment. We are more than willing to provide care within the guidelines of your insurance plan. It is however, your responsibility to know and understand those guidelines.
You must be prepared to provide your insurance card at every visit. ALL DEDUCTIBLES AND CO-PAYMENTS ARE DUE AT THE TIME SERVICES ARE RENDERED. This office files primary insurance for those which we participate. It is your responsibility for knowing your policy information such as co-payments and deductibles. We will not become involved in disputes between you and your carrier regarding deductibles or co-payments. In the event your health plan determines any service to be "not covered," you will be responsible for the complete charge. In that event, we will bill you and payment is due upon receipt of that statement.
Palm Beach Pain Consultants accepts most major insurance payers including:
Auto & Liability Insurance *
WORKERS COMPENSATION PLANS:
Choice Medical Management Services
Corvel Healthcare Corporation
USA Managed Care International
*Personal Injury Patients are accepted on a case-by-case basis
Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. It is given to all new patients, and a copy is available upon request.
WEST PALM BEACH OFFICE
1500 N Dixie Hwy, Suite 103
West Palm Beach, FL 33401
Phone : 561-833-8893
Fax : 561- 833-8939
Hours : Monday- Friday 9 am to 4pm