Practice Policies

Referrals  |  Payment  |  Forms  |  Medical Records  |  Patient Privacy

1. All insurance coverages and referral requirements are the responsibility of the patient.

2. Your insurance company requires us to collect co-pays and/or other fees to meet your annual deductible. Payment is expected at the time services are rendered. We accept most major credit cards, personal checks, & cash. There will be an additional $10.00 processing fee assessed if co-pays are not paid at the time services are rendered.

3. If your check is dishonored/returned for any reason, we will electronically debit your account for the amount

   of the check + $35 processing fee.

4. There is a $40.00 fee charged for all paperwork completed by staff or doctors. (i.e. Disability forms, FMLA

   paperwork, etc.) Please allow at least 3 business days for these requests.

5. Requests for copies of medical records: Pursuant to North Carolina code § 90.411 the fee is $10.00 plus 50

   cents per page for the first 50 pages; then 25 cents per page thereafter. Any applicable postage fees will also be assessed. There is a $10 fee to copy x-rays to disc. Please allow at least 3 business days for these requests.

6. NO SHOW POLICY: A $45 charge applies to missed appointments without prior notification within 24 hours.

7. LATE POLICY: Reappointment may occur if patient arrives greater than 15 minutes after scheduled time slot.