First Visit Paperwork

Practice logistics background

The logistics of healthcare can be tremendously complex. I have and do work with people in many ways (see “Background” page); my goal in current ongoing individual and relationship care in the US is to offer a setting with a personal feel, different from clinic or hospital encounters.

Working alone in this way, I don’t have a staff to help with logistical complexities. Clinics have staffs devoted to phone and paperwork details. I use a billing company, which is quite helpful with many aspects. I also ask folks I meet with to themselves sometimes help with clarifying/attending to logistical details if those are critical to allow us to meet. Thanks in advance for your understanding and assistance; please of course go over any questions with me, insurance and pharmacies, the billing company, etc. This cooperation allows this independent and personal sort of setting to continue. Some people prefer or need support in other settings instead, where they get more organizational support for logistical complexities. Do what you can to support more humane, accessible healthcare, in the US and globally.

First visit paperwork specifics:

If we’ve set a time by phone for a first face-to-face meeting, please look over these “first visit paperwork” documents below. You must provide three of them prior to our first visit, so I can have them in hand as we go over them. (There is no need to return the Privacy and Fees statement)

Since we will go over the forms, simply complete them as best you can –  we can clarify and refine details on them, when we first speak.

The four documents here are:

*Complete and return: Healthcare background formThis is the first of three documents which must be returned to me before our first meeting.

One “hat I wear” is that of a physician; of course to think and help most comprehensively, it’s important to understand each of us holistically. Sometimes there are general medical questions or issues which might be more of an influence on psycho-emotional experiences than one might think. Also, for insurance use, this documentation is needed. We of course go over specifics when we talk.

Going over such general body-mind info when we first meet doesn’t mean we will continue in such detail about issues which you are having other providers’ support for, but I just want at first to get a holistic feel for new folks and their support-surround in place, or perhaps to consider expanding.

Privacy and Fees statementYou may simply take a look at this online here, and print for your own records if you like. No need to return this to me. Part of the “Agreement” form (next) is noting that you’ve looked these over and gone over any questions with me (when we first meet, or certainly call me to discuss prior if that seems critical) – so do please look through this and ask any questions at any time.

*Complete and return: Contact etc Agreement This is the second of the three documents which must be returned to me before our first meeting. This gives your contact info and details about the parameters of us meeting. Again, simply complete as much as you can – we’ll discuss questions and finalize this at our first meeting and at any time.

*Provide and send a copy: An image of both the front and the back of health insurance card(s) – An image of BOTH SIDES of your insurance card – and of any card(s) of any secondary or additional health insurances currently applicable. This is the third of the three documents which must be returned to me before our first meeting. Delaying healthcare billing much beyond the first (and each subsequent) visit date can well lead to insurance payment denial. It is very helpful to the billing group I use to have images of your insurance card(s) – including as your coverage may change over time.

To recap:

Before our first visit, please let me have your:

  1. Healthcare background form
  2. Contact etc Agreement
  3. Health insurance card(s): images of front and back

(The Privacy and Fees statement is for your own review)

(Extra, occasional:  we’ll clarify if this is needed – don’t take the time to fill this out unless we’ve discussed this:  Release of Information)