Forms

STOP

Do not fill out forms until an appointment has been scheduled with our front office.

These forms are
ONLY FOR Dr. Bhargave, Cindy Duncan, Marcia Younker and Wykeisha Highsmith
and therapy intake forms can be found on the individual therapist pages.

We do not take insurance of any kind.
We request a copy of an insurance card, solely for the purpose of prior authorization for medications.

We are a self pay office and reimbursement from medicare is prohibited. If you have medicare, no claim can be sent for reimbursement by the patient. All appointments must be paid in full by the patient.
All other insurance policies, held by patients, can be filed by the patient for reimbursement, ie: appointments paid out of pocket by the patient.

Important: All initial appointment paperwork must be completed and submitted via the portal within 48 hours to secure the appointment time that was scheduled with our office. We do NOT take any insurance of any kind. We are a self pay office only.

New Patient Instructions:

Adults: Please fill out and submit all the forms in the Adult Patient Package prior to your first visit.

Children: Parent(s), please fill out and submit all the forms in the Child Patient Package prior to your first visit.