New Patient Forms

Click the button below to download and print off your new patient forms.  We humbly request you fill out these forms before your scheduled appointment to help expedite your check in process.  Thank you.

Download New Patient Paperwork

Welcome Letter

Welcome Letter – Spanish

New Patient Packet 2018

New Patient Packet 2018 – Spanish

Notice of Privacy Practices

Notice of Privacy Practices – Spanish

 

Insurance

We participate in most major health plans. We have contacts with many HMO’s, PPO’s, Insurance companies and Government agencies including Medicare and Medicaid. Our business office will submit claims for any services rendered to a patient who is a member of one of these plans and will assist you in any way we reasonably can to help get your claims paid. It is the patient’s responsibility to provide all necessary information before leaving the office. If you have a secondary insurance, we will automatically file a claim with them as soon as the primary carrier has paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request.

Co-Payments

Your insurance company requires us to collect co-payments at the time of service. Waiver of co-payments may constitute fraud under state and federal law. Please help us in upholding the law by paying your co-payment at each visit. For your convenience we accept cash, checks, debit cards, or the following credit cards: Visa, MasterCard, Discover, and American Express. If you do not have your co-payment your appointment may be rescheduled.

Additionally, you may have coinsurance and/or deductible amounts required by your insurance carrier. These amounts will be collected at check-out. We file your insurance as a courtesy to you, it is important that we have your correct information to properly file each claim. If your insurance does not respond in 45 days, we will transfer the balance to you for payment in full.

Late Arrivals

Please call ahead if you are running late 205-814-9284. A patient who arrives more than 15 minutes after his/her appointment is considered a late arrival. A late arrival, not considered to be the responsibility of the Practice, will be registered and worked into the schedule as soon as possible. If a patient is more than 30 minutes late, the appointment may be rescheduled.

Cancellation Policy

To be respectful of the medical needs of our patients please be courteous and contact Northside Medical Associates promptly if you are unable to attend an appointment. This time will be reallocated to another patient who needs treatment. This is how we can best serve the needs of all our patients.

If it is necessary to cancel your scheduled appointment we require that you call one (1) working day in advance. Appointments are in high demand, and your early cancellation will give another patient the ability to have access to timely medical care.

No Show Policy

Any patient who fails to arrive for a scheduled appointment without cancelling the appointment at least 24 hours prior to the scheduled time is considered a “no-show”. A no-show patient may be charged $25.00, as set by the Practice, for failure to show. A patient who fails to present themselves two times for scheduled appointments is considered a chronic no-show. A patient who is a no-show four times may be dismissed from the Practice.

Our Patient Portal

As a means of ensuring timely communication with our patients, we strongly encourage you to sign up for the Patient Portal, which can provide a quick and easy method for scheduling appointments, entering and updating medications, etc. As a new patient, you will receive instructions on how to sign up for the Patient Portal. If you have questions or need assistance, please feel free to speak with a member of our reception team.

Additional Information

If you have further questions or need additional information about our services, please feel free to call our office at (205) 814-9284 and/or our Contact Us page.