Becoming a Patient

Pre-appointment Paperwork:

• – Advanced Beneficiary Notice (ABN) (If Medicare is your primary insurance)

• – Demographics form

• – Consent to Evaluate & Treat

• – Financial Policy

• – HIPAA

• – Chronic Care Management consent

• – Medical Records Request

• – Medical History form

What to bring to your first appointment:

• – All of your medication bottles (or a list of everything)

• – Insurance card

• – Identification Card (ID)

• – Medical history forms (or be prepared to fill these out before your appointment)

• – Any issues you want to address that day or ongoing