New Patient Information


Thank you for selecting our practice.  We are committed to providing you with the best care and are looking forward to meeting you in person.


Your appointment has been scheduled especially for you.  If you need to change or cancel an appointment, please notify us 24 hours in advance or you may be charged a $25 to $50 charge.  If you are a new patient, please come in 30 minutes prior to your scheduled appointment.   Please make arrangements to have your medical records sent to our office in advance so our physician can review.  


Your insurance policy is a contract between you and your insurance company.  We bill your insurance company as a courtesy to you when provided with current information and an assignment of benefits.  If your insurance requires a co-pay, it must be paid prior to seeing the doctor.  On your initial visit you may be required to pay at the time of service if we are unable to verify your insurance.  Please be aware that you are ultimately responsible for your bill.  We are a Medicare provider and accept many different PPO and HMO insurances.  Please make sure that Mercy Physicians Medical Group is the network you have selected and that one of our physicians is your primary care physician and that you are eligible at the time of service.  if you are not a Medicare patient, PPO patient, or HMO patient, payment is collected at the time of service.  For your convenience, we accept cash, checks, and credit cards.


Thank you again for choosing our physicians.  Our staff is available to answer your questions regarding our office policies.  We hope your experience with us is a pleasant one.


New Patient Documents

09/17/2013 09:25
doc05139120130917091703.pdf (182265)