Patient Forms

Our office is committed to providing quality and cost-effective healthcare to our patients. It is essential that you understand what services are covered by your Workers' Compensation Insurance and obtain all authorizations from your Employer Representative or Workers' Compensation adjustor PRIOR to your appointment.

If you have not received prior authorization, an attempt will be made to contact your Employer Representative or Workers' Comp adjustor. If we are unable to reach or obtain verbal authorization from your Employer Representative for your worker's comp appointment, please understand that your appointment may not be approved under worker's compensation and you may be responsible for all expenses associated with the doctor's visit.

To summarize, it is the patient's financial responsibility if the Employer Representative or Workers' Comp adjustor does not authorize and agree to financial responsibility for the doctor's visit