Please click on the link below and print
the registration packet.
Fill it out completely and bring it
with you 30 minutes before your appointment.
REGISTRATION PACKET
PLEASE FILL OUT
PAPERWORK AND BRING TO SCHEDULED APPOINTMENT.
BRING INSURANCE CARDS & PHOTO ID TO BE COPIED FOR YOUR CHART.
BRING COPAY
IF YOU HAVE ONE TO BE PAID AT TIME OF VISIT
(IT WILL BE FOR A SPECIALTY CLINIC).
IF YOU DO NOT HAVE YOUR COPAY, INSURANCE CARD, OR PHOTO ID AT THE
TIME OF YOUR VISIT WE WILL HAVE TO RESCHEDULE YOUR APPOINTMENT.
IF YOU ARRIVE AFTER YOUR APPOINTED ARRIVAL TIME WE WILL HAVE TO
RESCHEDULE YOUR APPOINTMENT.
Office Hours and Appointments
The office is open Monday through Friday from 8:00 a.m. to
4:30 p.m. Our physicians are available for emergencies 24 hours a day; 7 days a week.
Other Languages Spoken
- Spanish
- Interpretation services
for other languages can be arranged.
What
to Bring to your Appointment
For your
visit, please bring your insurance card(s), photo ID and a list of your current medications. Due to new privacy laws (HIPAA)
we will need the insurance policy holder's social security number in order to submit the claim.
If your insurance plan requires a written referral form please bring the form to your appointment
and give it to our receptionist when you arrive. If you are unsure as to whether or not you need a referral form, please call
the member services number on your insurance card.
Co-payments
and balances are collected at the time of service. We accept cash, personal checks or VISA/Mastercard & AMEX.
No Show Policy
We require a minimum of 72 hours notice ofcancellation
of any procedure, or a $100 charge will be assessed.
A $25.00 charge will be assessed for "no showing" or failing to give 24 hour notice of the
need to cancel all routine appointments. This charge is not billable to the patient's insurance company and will
ultimately be the responsibility of the patient. All no show charges will need to be paid before the next appointment
with the physician.
Any established patient who
fails to show for appointments on three (3) occasions will be discharged from the Clinic.
All patients arriving AFTER the appointed arrival time will be considered
as a late arrival and will be required to reschedule their appoinment.
New Patients
Please arrive about 30 minutes early for your first visit. It is necessary for you to complete
both demographic and medical history forms prior to seeing your doctor. If you have lab work or recent x-rays relevant to
your visit, please bring them as well.
At Digestive and Liver Disease Consultants, P.C. your time and convenience are important to us. Therefore
we are happy to provide you with the simplicity of pre-registering online for an upcoming office visit.
By opening
and printing the forms at the top of this page ahead of time you will save time upon your arrival to our office.
Please bring the completed forms with you at the time of your appointment.
When you have Questions
We realize you may have questions in between scheduled visits. Our office staff will relay questions to our
nurses and physicians, as needed, and get back with you promptly. During office hours, our registered nurses will forward
information concerning medical emergencies to our physicians. After hours and on weekends, the "on-call" physician
can be reached through the answering service.
Test
Results
We will call you if your test
results indicate something needs to be addressed immediately. If you have not heard from our office within three weeks, please
call us directly to obtain your results.
Payment
Information
Digestive and Liver Disease
Consultants, P.C. participates in most major health plans including:
- Medicare
- Blue Cross/Blue
Shield
- United Healthcare
- Coventry
- John Deere
- Many other miscellaneous plans
Our acceptance of a specific health plan is subject to change.
Cancellations
If you are unable to keep an appointment, please give us at least 24 hours notice for
office visits and 72 hours notice for procedures.
Requirements for Refill of medications Please do not call the clinic for your refill:
We ask that you notify your pharmacy directly to ensure we have the most up-to-date medication information. Allow 48 hours: Please
allow 48 hours for your refill request to be reviewed and approved. We are not open on weekends, so refills
requested on Saturday and Sunday will not be received until Monday. A written prescription is a legal document and needs to be taken to your pharmacy.
Telephone or fax authorization will not be given for prescriptions that have been written. Please coordinate your refill needs with your doctor’s
appointment whenever possible. There are more frequent visits required to be on certain medications.
Lab testing is also required for certain medications and your request will not be refilled unless we have the lab test
results.
Due to the fact
that your health condition can change over time, we do not authorize refills if it has been more than one year since you have
been seen by a doctor in our clinic. Med
refills will only be addressed during office hours Thanks for assisting us by planning ahead for your medication needs.