• Your insurance card
• Physician referral forms if required by insurance
• A list of current prescriptions and/or over-the-counter medications you are taking, including dose and frequency
• Pertinent information about your medical and surgical history
• Any recent x-rays or appropriate records you may have
• A valid driver’s license
• The address and phone number of your pharmacy
PLEASE print at home and COMPLETE FORMS BEFORE you come to your appointment.
If unable–PLEASE COME 30 MINS EARLY TO COMPLETE FORMS.
If you do not arrive early or do not have your forms completed- we may have to re-schedule you.
The Advanced Center for Pelvic Medicine is a provider for Medicare and most major insurance plans. We provide insurance billing. Anything not covered by insurance will be your responsibility.
We request payment at the time of your appointment for services that are not covered by insurance. Your insurance company may also require you to pay a co-payment at the time of your appointment. When necessary, our staff will work closely with patients who require a payment plan.
If you have any questions regarding which insurance plans we accept or any patient billing concerns, please call us at the phone number below. Questions regarding your coverage and benefits should be directed to your employer or insurance company.