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Patient Forms
The office has a 15 minutes grace period policy. If you arrive more than 15 minutes after the scheduled time of your appointment, we may require you to reschedule in order to avoid delaying other patients' appointments. Exceptions may be made at our discretion, depending upon the circumstances and time constraints. Please make sure you always have your actual insurance card (no temporary or print out will be accepted), picture ID, and a valid referral, if necessary, at the time of your appointment. Failure to provide these documents will result in your appointment being canceled or be asked to be self pay for the visit. We apologize for any inconvenience. You must also inform the office of any change in your information such as insurance, address and telephone number, etc. If new insurance information is not given prior to your appointment, your appointment will be canceled until the office obtains the information or you can be self pay at the time of service. We apologize for any inconvenience.
We must collect your required co-pay at every visit. We accept cash (exact change only) or check. All returned checks are subjected to a return check fee of $35. Also, if payment is not paid at the time of service, a $10 billing fee will be applied. Appointments for regular care that are not canceled at least 24 hours before the scheduled appointment during hours of operations are subject to a $30 "No Show Fee." Appointments for Functional Capacity Exams that are not cancelled at least 24 hours before the scheduled appointment during hours of operations are subject to a $200 "No Show Fee." Appointments for Neuro-Psychological Tests that are not cancelled at least 24 hours before the scheduled appointment during hours of operations are subject to a $500 "No Show Fee." On the first visit you will be required to complete the following forms (Initial Visit Questionnaire and Patient Registration). If you have any health records from previous physicians, please bring them with you. You may print and fill out the forms in advance to save time. Please also bring a list of any medications you are currently taking. We suggest that all new patients plan to arrive 15 minutes before their appointment time to allow for processing. All existing patients are required to fill out the Follow Up Questionnaire; you may print out the form prior to your appointment to expedite your visit. Please also bring a list of any medications you are currently taking. All patients are required to fill out a new patient registration form at the beginning of the year, every 6 months and whenever any of information changes. All the forms can be printed out and completed prior to the visit for faster service. We do not accept all insurances, so please call your insurance company to verify if the physician you would like to see is in network. Since we have several physicians that have their own private practice, when calling your insurance company, verify that the physician is participating under Washington Medical Group, P.C. Patients are responsible for knowing their insurance benefits. There is a 72 hours processing time for referral request. Please fill out the form on the website completely and if calling, have the physicians name, address, phone number, fax number, reason for the referral, and your insurance information. Any incomplete information may cause a delay on your request. No backdated referrals will be given. There is a 48 hours processing time for prescription request. Please be advised that some of our physicians are not in the office full time so allow sufficient time to process your request. Call ahead of time before running out of your prescription. Any incomplete information may cause a delay on your request How can I get diagnostic results (laboratory, radiology etc)? Obtaining test results require a face-to-face consult with a licensed medical professional. Test results cannot be given over the phone, email and/or via facsimile. These regulations are in compliance with appropriate medical care guidelines and other government agencies within the District of Columbia. How can I find out what my co-payment is? There are three ways you can find out the cost for your co-payment. You can call your insurance, look at your benefits via online or talk to your Human and Resources administrator. Can I be billed for my co-payment? We are required by insurers to collect your co-payments at the time of service. However, in an event that you are unable to make a payment at the time of your visit, you will be billed for the amount of your co-payment and an additional $10.00 fee. How can I get a copy of my medical record? If you desire your own copy, there is a minimum charge of $30. You must provide the office a written request for your medical record or fill out the patient medical record request form. Any incomplete information may cause a delay on your request How can I request for my medical record to be forwarded to another physician? We will make a single copy to send to another physician's office at no charge to you. You must provide the office a written request or fill out the medical record request form. Please include the physician's name, address, telephone number and fax number. Any incomplete information may cause a delay on your request What do I need to do if I am scheduled for surgery? Find out first if you need a preoperative physical exam. Your surgeon's office can tell you this. If so, call to schedule it as soon as you know the date of your surgery. Allow sufficient time for all your test results to be performed and for the results to come back. This may take up to 2 weeks or more. |
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