Call 831-600-7381 or email firstname.lastname@example.org to request an appointment.
We are in network with
Please arrive 15-20 minutes early for the initial evaluation. Download, fill out and bring the following forms with you to your first appointment.
Download and bring all of the following:
Medical History (all 4 pages)
HIPPA: Acknowledgement of Receipt of Notice of Privacy Practices
Office and Billing Policy (Assignment of Benefits)
In addition, please bring:
Patient forms to be reviewed (they do NOT need to be printed)
All Insurance Cards
All medical records and imaging pertaining to your current condition (most recent Doctor’s notes, Radiology report(s), Surgery report(s), X-ray(s), MRI(s)
Any co-pay or deductible as required by your insurance
Outcome Measure that applies to your injury (see below)
Here are the outcome measures that needs to be completed according to your injury (see description for the corresponding form):
Prior to your evaluation it is suggested that you call the Member Services department of your insurance company and verify what your responsibilities may be regarding co-pays, deductibles, referrals, etc. Please remember that benefits quoted are NOT a guarantee of payment per your insurance.
Cancellation Policy: Please call our office 24 hours before your appointment if you need to cancel. Late cancellations and no show appointments are subject to a $50 fee.
Please call our office at (831) 600-7381 if you have any questions.
We look forward to seeing you!