Rooted in Santa Rosa | Reaching New Heights
Forms and Policies
Appointments
Our office sees patients by appointment only; we are unable to accomodate walk-ins.
We make every effort to see patients with urgent or emergent conditions in a timely manner.
While we strive to keep appointments running on schedule, some visits may require more time than anticipated. We appreciate your understanding and encourage you to allow flexibility in your schedule following your appointment.
Patient Forms
The following three forms are for all patients coming into our office for an appointment. These forms can be downloaded to your computer and printed at home. By filling these forms ahead of time, you will save time during your visit. Please be prepared to provide this information to our office along with your current medical insurance information. If you have any questions when filling out these forms, please do the best you can and our staff will assist you on the day of your appointment.
Payment Policy
Co-payments are collected at check-in at the time service is rendered. For your convenience, we accept cash, checks, and credit cards (Visa, Mastercard, AMEX, and discover). If you are unable to pay your insurance co-payment, your appointment will be rescheduled.
In certain emergent situations, payment plans may be established for patients with significant financial distress. If you are on a signed payment plan and a problem arises that affects your ability to continue making timely payments, you must contact our office immediately. In the event that your account is placed with a collection agency, no further appointments will be made until prior debt is resolved.
A fee of $35.00 will be charge to your account for returned checks. From that point on, we will only accept cash, money orders, or credit cards for any payments currently due on your account for future medical services rendered.
Arbitration Agreements
Our office uses arbitration agreements.
All patients are required to sign the agreement before being seen.