Patient Policies

Welcome to our practice and thank you for choosing us to serve your healthcare needs.

We have put together this policy page to answer many of the questions that you may have. The more you know about our policies and methods of practice, the better we may be of service to you. If you have any questions, please do not hesitate to contact us. It is our desire to provide our patients the best medical care possible and to maintain a personal and long-lasting relationship with you and your family.


Appointments can be made by calling our practice directly. Alternatively, you can fill out the Request for an Appointment form on this website. Please bring your current insurance card, referral form if required, a list of any prescription(s) you are currently taking or refills needed and a list of any questions you may have. If you would like to ask us any questions before your appointment, please fill out a Contact Form to help assist you during your visit.

Patient Forms

The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time you will save significant time at the time of your visit. If you have any questions when filling out these forms, please do the best you can, our staff will assist you with your questions on the day of your visit.

Please printout and complete the appropriate forms:

Note: The above documents are in Adobe® PDF format. They require Adobe Reader to be viewed. If you do not have Adobe Reader, you can download it for free by clicking here.

Billing and Financial Policy

For all services that require the use of your health insurance, we will file the claim and bill your provider. However, patients are responsible for any required co-payments or outstanding balances. Payments are expected in full at the time of visit.

Billing Information

The financial policy set forth is that payment is required for your services at the time your services are rendered. Co-payments and balance dues are expected to be paid in full at the time of service. We will provide insurance claim filing for the insurance plans that we participate in. If there is a balance due after payment is rendered by the insurance company, we expect your prompt payment of that balance.

It is the patient’s responsibility to provide us with current insurance plan information prior to services rendered in order for accurate billing of services to be filed. As a health care provider, our relationship is with our patients and as a team; we continuously follow up on outstanding claims. At times, we may require the patient’s intervention to assist us and we appreciate the patient working with us in this regard.

In order to accommodate the needs and requests of our patients and the community, we have enrolled in various managed care plans. While we gladly provide this service to our patients, it is important for the patient to be familiar with the guidelines of their insurance plan requirements regarding authorizations, deductibles, co-payments and other vital requirements.

Cancellation Policy

Please contact the office at least 24 hours in advance to cancel appointments, failure to do so could result in a fee (equivalent to the visit co-payment). Failure to do so can inconvenience the medical team and our other patients, therefore affecting our ability to deliver our high level of quality care.

Emergencies and On Call

If you have an emergency, please call the office number which will be redirected to the answering service after hours. You can expect a call back within 30 minutes. If you cannot wait for a return call or have an emergency situation, please go to the nearest Hospital Emergency Department.

Lab and Test Results

Lab and test results will be discussed with patients at a follow-up appointment. Upon completion of the specific test(s), further instructions will be given as to how and when the results will be made available.

Late Policy

If you are going to be more than 10 minutes late for your appointment, we request that you call our office. If the schedule allows, the appointment time will simply be moved to accommodate the delay. However, if our schedule at that time is unable to handle the tardiness, we may request you reschedule your appointment. We work diligently to try and stay on schedule and suggest that you arrive 20 to 30 minutes prior to your appointment time to allow time for any necessary paperwork.

Prescription Refills

Calls for prescriptions received in this office after 12:30 p.m. will be addressed the following day after 2:00 p.m. Please try to call the office at least 48 hours in advance for all medications. Calls received after 12:30 p.m. Friday will be returned after 2:00 p.m. on following Monday.

Physician and Specialist Referrals

Please call the office at least three (3) days before the appointment to give us the information needed to complete the referral. That information includes: your name, the physician you are being referred to, his/her phone and fax numbers, the date of the appointment, the diagnosis for the referral, your insurance, whether it is for a visit or a specific procedure and where it is going to be performed (office or hospital). We do not mail referrals to specialists. Please familiarize yourself with your insurance plan, and determine if it requires you to take a referral with you.

Records Release

Please complete the records release form (Authorization to Release Form) to obtain your medical records from your previous family physician and any specialists you may be consulting. Our Practice Privacy Policy is available at the office for your review.


For more information about Myrtle Medical Center please call