Forms & Policies

Forms

We encourage you to download and complete the patient forms prior to your visit.

pdf-icon  Intake Form
PDF  Patient Information

These forms require Adobe Acrobat Reader, if you wish to download it, click here.

Policies

Payment

All office co-pays and deductibles are to be paid at the time services are rendered. This includes applicable co-insurance and co-payments for participating insurance companies. We accept checks, cash, Visa, and MasterCard credit cards.

Scheduling of Appointments

New patients can call to make an appointment, but they must provide the referral information prior to the visit. Fax number: (443) 542-0983.

Late Policy

If you are more than 15 minutes late for your appointment, you will have to reschedule and a visit fee will be charged. If you know you may encounter traffic problems, please plan to leave your home or work earlier.

Cancellations

Please call at least 24 hours in advanced if you need to reschedule or cancel an appointment.

No-Shows

In the case of a “no show” or untimely cancellations, the patient will be billed and charged a $50 fee.

Insurance

Please bring your up-to-date insurance card(s) with you to every visit. This is to ensure that the information we have is correct, and that your plan is current and an insurance plan in which we participate.

Disability Forms

Forms are completed at the discretion of Spine and Rehabilitation Physicians, usually between 2 and 5 business days.

The completion of the forms/letters will require an office visit for assessment.

There will be a charge that must be paid prior to the completion of the form. The charge will be determined by the time required and complexity of the request.

We reserve the right to refuse to complete a form if it requests information that we do not have as a part of your treatment with us.

General

Bring photo ID at all times

The clinic reserves the right to discharge patients for non-compliance with the office policies.