Your First Visit
Once you have made your initial appointment, you may pre-register by downloading, printing, and completing the forms below. Please be sure to bring them with you to your first visit.
Completing the forms prior to your visit will help speed up the new patient registration process.
Please complete ALL of the following forms:
- Patient Registration (complete ALL seven pages)
- Photo identification card (driver’s license) of the patient or responsible party
- Insurance card(s) and the address of your primary and secondary (if applicable) insurance company
- Insurance office visit co-payment or co-insurance (we accept cash, checks, and most major credit cards)
- X-rays, MRI scans, or any other diagnostic films or test results that may have been ordered or performed by another physician.
- If your insurance requires that you have a written referral before seeing a specialist, please bring it on the day of your appointment. It is your responsibility to obtain the referral.
- If you do not have insurance, a deposit of $250 to see a physician or $150 to see a nurse practitioner/physician assistant is due on your first visit and payment arrangements will be set up for any outstanding charges as they are incurred.
Our receptionist will schedule or reschedule your appointment or take a message to give to your physician’s nurse who will then contact you. If you are unable to keep your scheduled appointment, as a courtesy we ask you to give us at least 24 hours’ notice.
Our physicians work hard to keep all patient appointments. However, your physician may occasionally be late if called to the hospital for a medical emergency or he has a surgery that takes longer than expected. We appreciate your understanding and patience at these times.
We look forward to serving you. If you have any questions prior to your first visit, please do not hesitate to call us at 501-329-1510.
Children over the age of 18 may seek treatment without their parent or guardian being present. The patient must have completed the appropriate paperwork and signed the consent to treat form. The patient must also submit current copies of the insurance card (may be on the parents’ insurance up to age 26) to which the services are to be billed.
Children under the age of 18 and who are not emancipated minors or married must have one of the following adults with them during all visits:
- Parent (biological mother or father)
- Step-parent (must have written release from biological parent)
- Grandparent (must have written release from biological parent)
- Guardian (must have appropriate documentation)
- Sibling of patient who is 18 or older (must have written release from biological parent)
All of the above persons must have the following information with them at the time of the visit:
- Original or copy of current health insurance card.
- Signed consent to treat release (may be obtained on web site)
- Completed injury forms