NEW PATIENT INFORMATION & FORMS

Please complete this form and bring it to your first appointment. It asks for information about your current problems and past medical history.  It will give your doctor a better understanding of your problem, and will allow us to spend more time discussing your treatment with you.
858-300-1145 New Patient Fax Number

Please click to download and fill out completely the New Patient Info Packet:

The New Patient Packet Contents:

Enclosed you will find several forms; which we ask that you complete and bring with you to our office prior to your consultation. Please arrive thirty (30) minutes prior to your appointment; this will help expedite the process of setting up your account. If your paperwork is not completed prior to your appointment time, you will need to be rescheduled.

Please bring the following to your first appointment to ensure your appointment is on time:

  • New Patient packet
  • Relevant test results, MRI, X-rays and records
  • Proof of Insurance
  • Insurance Co-pay
  • Identification

IPS_neckOur office will obtain records from your referring physician prior to scheduling your appointment. If you have any additional records or radiology studies you would like to have reviewed, bring them to your appointment. Please arrive a few minutes early so that we can get them into your chart for the doctor’s review.

Upon check-in with the receptionist, please provide your identification and insurance card(s) to copy for your chart and pay any co-pays that apply. If your co-pay is not paid at the time of service there will be a twenty ($20) charge to bill for a co-payment.

Our Practice focuses on one-on-one personalized service, quality care and attention to detail. To do so, we must ensure that we allow enough time for each patient’s appointment. With this in mind, for all appointments longer than one hour, we require indication of commitment by payment at the time of scheduling.

CANCELLATION POLICY

In the event that you must cancel your appointment, the following is our cancellation policy.

Appointments: 48 hour notice or $45 charge

Procedures Scheduled 1 Hour or Less: 48 hour notice or $100 charge

Procedures Scheduled Longer Than 1 Hour and Less Than 2 Hours: 72 hour notice or $175 charge.

Procedures Scheduled 2 Hours or More:  7 day notice or $500.00 charge

We look forward to meeting you at your consultation with Dr. Smith.