If you are a new patient to our office, at your first appointment we will ask you to fill out a Patient Information Form and Health History Questionnaire. These forms ask for personal information such as your address, employer, emergency contacts, allergies, and guardian information in the case of minor patients. The Patient Information Form is part of the financial policy section of the packet which asks for insurance information as well as insurance cardholder information. Please read the insurance section that pertains to your coverage. We will also need a copy of your ID, as well as insurance cards. In the case of a Power of Attorney, we will need a copy of the proper documentation. You are also asked for your Social Security number. We understand that it is your right to keep your SSN confidential; however, it is required for billing your insurance and for collection agencies. Therefore, if you decline to give your SSN to us, you will be required to pay in full at the time of service for every visit and are welcome to bill your insurance on your own.
Please be advised, our office is not an authorized Tricare/Champus provider and we do not accept this type of insurance. We will only accept VA as a form of payment if the visit is for emergent treatment follow up.
At the end of our patient information packet, you are asked for a signature acknowledging that you have been offered a copy of the Denali Orthopedic Surgery, P.C. Notice of Privacy Practices (a.k.a. HIPAA) Packet. If you would like a copy of the HIPAA packet, you may request one at our office or download a copy from the link to the right.