Forms / Insurance / Billing

Upon either your first visit or return visit, please bring the following items with you:

  • Insurance Card(s)
  • Picture identification
  • Information about any health care providers or tests you might have seen or received since your last visit with us, for better care coordination.
  • Current Medication list with dosage, strength, etc.
  • Previous test results
  • Required Co-Pay, Deductible or Co-Insurance

Also, please be prepared to share your medical history with our staff. You may be asked questions about any current medical conditions you have or may have had in the past; previous surgeries, family history, any medications (whether prescription/RX or over the counter/ OTC), or allergies you may have to foods or medications.

If you are unable to keep an appointment, please call the office at least 24 hours in advance to reschedule so as to give other patients who need help a chance to be seen.


We are affiliated with Piedmont Clinic and Piedmont Hospitals and accept the same insurance plans. If you do not see your plan below or have a question about your specific plan, please call your physician’s office or call your insurance company.

  • Aetna PPO/HMO/EPO
    Beech Street PPO
    Blue Cross Blue Shield HMO/PPO/PAR
    Cigna/ HMO/PPO/POS
    Coventry HMO/PPO/POS
    First Health PPO
    Humana HMO/PPO/POS
    Humana Medicare Advantage/HMO/PPO
    Kaiser POS/PHCS
    Lifewell PPO
  • Medical Mutual of Ohio PPO
    NovaNet PPO
    Private Health Care
    Systems/PHCS PPO/POS
    Tricare Prime HMO
    Tricare Standard PPO
    United Healthcare
    Assurant Health
    Group Resources

PLEASE NOTE: The amount of your co-pay, deductible or co-insurance is determined by your health insurance company. It is NOT a number that your physician’s office sets or changes arbitrarily. These payments are required by your insurance company and are due at time of service. We accept cash, checks, debit cards and all major credit cards (AMEX, VISA, MASTERCARD, DISCOVER).

Forms (click to open)

To view and fill out the forms listed, you will need Adobe Reader. This is especially important for Mac users, as these forms will not work as intended using anything other than Adobe Reader. You may download Adobe Reader for free at*Note*- some browsers use their own built-in PDF viewer. If issues arise, save the document to your computer and re-open using Adobe Reader.