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New Patient Packet


                                    YOUR TIME IS VALUABLE.    

NO ONE WANTS TO SIT IN AN OFFICE ALL DAY WAITING TO BE SEEN, SO GIVE US A TRY!
Appointments are preferred -- Walk-ins are welcomed and accepted on the basis of time availability.

You will also need the following;

1- PHOTO ID is required, if under 18 years of ago and no photo ID is available, a parent's ID is necessary. This policy is in relation to new Identity-theft regulations.

2- INSURANCE CARD, MEDICAID CARD, MEDICARE CARD, if applicable. We will not be able to bill your insurance without proof from the insurance member. If you have questions about your health benefits, we recommend you call the customer service representative at the phone number location on your insurance card for assistance.

3- Co-pay, co-insurance percentage, or any applicable fees as determined by your type of insurance. Payment is due at time of service.

4-If the patient is a minor [under 18 years old], a parent, grandparent, guardian, or court appointed custodian will need to be present for new patients. Established patients under 18 years of age may be seen without a parent, grandparent, guardian, or court appointed custodian if prior arrangements have been made. Speak with office manager, Susan King, Office Manager 662-560-5966 for details concerning these visits. Susan is available from 8am to 4 pm.

 Thank you for your interest!

EASY, PRINTABLE FORM. BRING IN WITH YOU TO SPEED UP THE PROCESS.

CLICK ON THE LINK BELOW.


Patient Registration.pdf

For DOT or Industrial packets, please contact Susan King, Office Manager for quotes and further information that is customizable for your company's needs.


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