NEW PATIENT REGISTRATION FORMS
Please print, fill out and bring them with you to your first appointment with the doctor.
Mental Health Benefits often have different set of rules than your other medical benefits:
Your co-pay, co-insurance, or deductible requirements might differ.
You might require a precertification (authorization) for mental health specialist - if this is a case, the Patient is responsible for obtaining precertificatin PRIOR TO first appointment.
You might require a refferal from your PCP.
There might be a limit on the number of allowed office visits.
There might be restrictions on length and type of your appointments.
There might be a limit on the $ amount allowed for mental health per year.
There could be some other restrictions, not mentioned above.
For these reason we strongly recommend that you call your insurance company before the first visit. You may also fax us or e-mail the copy of your insurance card (front and back) and patients DOB, and we will check the benefits for you.
Fax: 813 464 7682 (both locations)
Dignity
