Policies/Forms

Forms

Please complete the form with all required information.  By clicking “SUBMIT” at the end of the form, you agree that all information is correct, and that you have read and understand terms as included in this form.

Policies
HIPAA Privacy Policy – How At Your Door Visiting Healthcare may use and disclose health information.

Billing
We accept most health insurance plans, and as a courtesy we will submit the patient’s claims to the carrier directly. Because we are unable to keep up with the vast array of medical plans and what each one offers, it is the patient’s responsibility to notify our office in advance if a procedure or visit to a specialist needs a referral.

Any co-payment and any unpaid balances will be billed to the patient or power of attorney.
Self-pay patients are expected to pay the full amount of the visit at the time of service.