General Surgery Patient Forms & Information
For expedited registration, please download and fill out the packet and bring it with you to your appointment.
Self Pay Notice
Informacion de Paciente
Historia De Salud
Notificación de Prácticas de Privacidad de HIPAA
Notificatión de Pago Propia
PRESCRIPTION REFILLS: Please call your pharmacy at least one week before you are out of your medicine so that they will fax us a request for a refill. Our office needs at least 72 hours for all prescription refills.
UNINSURED PATIENTS: Payments for services is due at the time of services. For your convenience, we accept VISA, Master Card, cash, checks, and money orders. If the patient is unable to make full payment you can discuss payment arrangements with our billing department.
INSURANCE PATIENTS: We will bill most primary and secondary insurance carriers for you upon receipt of a valid insurance card. Please be aware that although we participate with most insurance companies, it is your responsibility to make sure we are a participating provider with your plan.
AUTO OR WORKER'S COMPENSATIONS: We accept services for auto or worker’s compensation patients as long as an authorization is in place.
CANCELLATION POLICY: Our office requires 24 hours notice for the cancellation of appointments.
ADDITIONAL CHARGES THAT YOU MAY BE RESPONSIBLE FOR:
- Returned Checks $25.00
- Copies of Medical Records $25.00 first 10 pages, $1 each additional page
- Missed Appointments $0
OVERPAYMENTS: We will not refund credit balances less than $1.00.
WHAT SHOULD I DO IN THE EVENT OF AN EMERGENCY: We are always available in case of an emergency. Call 911 for all life-threatening emergencies and the hospital will notify your provider.
SCHEDULING APPOINTMENTS: Our clinic is open from 8:00 am - 5:00 pm Monday thru Friday. Closed during the lunch hour 12 pm – 1 pm. Appointments may be made by calling 575-556-6400 from 8:00 am – 5:00 pm, Monday through Friday. You will receive the first available scheduling time. We do our best to not reschedule and to be on time for your appointment but there are occasions because our providers are on call and do occur surgery emergencies that we may have to reschedule your appointments or we may run behind. We ask for your patience when this occurs.