What you need to know before your appointment

It is very important that you, as a new patient, bring the following with you. New HIPAA rules require we collect certain information to protect your identity and Private Health Information (PHI)

You, as a new patient, will need to show and provide:

• Your insurance card or other health coverage information. Some insurance companies require you to have a referral or primary care authorization before treatment is given. Please check with your carrier if you are in doubt.
• A valid photo identification card or valid driver’s license
• A signed acknowledgement of receiving our privacy policy
• The list of who we can release PHI and what PHI we can release

Dr. Graham Smith needs as much information as possible to help determine the primary cause of your pain complaints.

Please bring the requested items with you to appointments:

• X-rays/ MRI’s/CT’s/ any imaging or studies not older than eighteen months (if available)
• Clinic notes or operative reports from your referring physician that relate to your condition.
• A list of any medication including doses and strength (ie mg) regardless of who prescribed them
• A list of all over the counter medication and supplements including how and when you take them, and strength
• If a third party is providing medical records and/ or your imaging, it is still your responsibility to verify that are received before your appointment

New Patient – Please be aware of the following:

• All patients are asked to wear undergarments (you will need to put on a gown to be examined)
• We ask that all cell phones be turned off during your appointment. If you have a critical situation that requires your phone to be on, you must notify one of Dr. Graham Smith’s assistants before you see the doctor
• We strongly encourage parents to make arrangements for childcare the day of your appointment. Dr. Graham Smith wants to give you his full attention and asks the same of you. If you are attending to the needs of your children, the distraction may interfere with your appointment.
• Please block a minimum of 2 ½ hours for your initial appointment. If you have schedule restraints, please advise the new patient coordinator when you make your appointment
• We will under no circumstances release information about appointments, tests or procedures, or allow anyone to pick up prescriptions or records unless you have given prior authorization in writing.

About your financial responsibility:

Payment in full is expected at the time of your visit. Exceptions include Worker’s Compensation, Medicare and patients covered by contracted Insurance Carriers. Deductibles, co insurances and co pays will be collected according to your contract specifications before your visit. All insurance is verified including deductibles still due and co-pays. It is your responsibility to know the terms of your medical insurance before your visit. For your convenience, we accept Visa, MasterCard, cash or check. Please contact our billing office if you have any questions or concerns.

Forms

New Patient Information

New Patient History

New Patient Financial Agreement

Please see Directions and Map to Dr. Graham Smith’s office on our Contact Page.