Please call 540-434-2255 to set up an appointment.
We would like to make the registration process for
your office visit as efficient and uncomplicated as possible.
The following tips can assist you with the process.
Please remember to bring your most recent insurance card(s) and a
photo ID; due to new federal regulations, these documents are required to
be shown at each and every visit.
NEW PATIENTS
If you are a new patient, it is our pleasure to
welcome you to the office of Michael A. Alexiou, M.D. at Alexiou Hearing
and Sinus Center.
Please click on the new patient tab and download all
of the forms listed and fill them out at your convenience prior to your
appointment. Please bring
these forms with you on the day of your visit.
If it is not possible to work on these forms prior to your visit,
they can be filled out in the office.
If you choose this option,
we request that you arrive at least 15 minutes prior to your scheduled
appointment time to allow sufficient time to complete all necessary
paperwork. In addition to the
forms, you will need to bring a
photo ID and all insurance cards and as always, your co-payment is also
due at the time of the visit. If you are not the subscriber of any of
the insurance that you carry, you must have the subscriber’s information,
including his/her date of birth and social security number.
Without this information we will be unable to file with your
insurance carrier.
Although the Heath History Form is three-pages long,
we are asking that you complete
only those areas that are relevant at this time.
You will also need to include a list of all medications taken, both
prescription as well as over-the-counter, including their dosages.
ESTABLISHED PATIENTS
If you have not been seen in the office for 12 months
or more, please click on the established patient tab and download all of
the forms listed and fill them out at your convenience prior to your
appointment. Please bring
these forms with you on the day of your appointment.
If it is not possible to work on these forms prior to your visit,
they can be filled out in the office.
If you choose this option,
we request that you arrive at least 15 minutes prior to your scheduled
appointment time to allow sufficient time to complete all necessary
paperwork. In addition to the
forms, you will need to bring a
photo ID and all insurance cards and as always, your co-payment is also
due at the time of the visit. If you are not the subscriber of any of
the insurance that you carry, you must have the subscriber’s information,
including his/her date of birth and social security number.
Without this information we will be unable to file with your
insurance carrier.
IMPORTANT
REMINDERS FOR ALL PATIENTS
NEW PATIENTS:
If you have had any recent x-rays, CT or MRI scans, please bring a copy of the x-ray and/or CT films; in the case of an MRI scan, a copy of the report.
ALL PATIENTS:
·
A current medication list is helpful so
that we can provide safe and accurate treatment.
·
Referrals (if necessary) are the
responsibility of the patient.
Please make sure proper referrals are obtained prior to your visit.
·
Bring your insurance card and photo ID with
you to each visit. Failure to
present this information at the time of the visit will result in your
being responsible for the full cost of the services provided or your will
be given the option of rescheduling the appointment.
·
Copays and payment for any past due
balances are due at the time of the service.
The appointment will be rescheduled if you are unable to pay your
copayment.
As a courtesy to our patients, reminder calls are placed 24-48 hours prior to your appointment. We request that if you know that you will be unable to keep your appointment, call our office in advance of the appointment to avoid the possible assessment of a no show/same day cancellation fee.
FORMS
NEW PATIENT
Patient Registration
Health History
Financial Policy Statement and Agreement
HIPAA Notice of Privacy Practices
HIPAA Patient Acknowledgement
ESTABLISHED
PATIENT
Patient Registration
Health History
Financial Policy Statement and Agreement
HIPAA Patient Acknowledgement
RELEASE OF INFORMATION
PATIENT
INSTRUCTION SHEETS:
Endoscopic Sinus Surgery Discharge Instructions
Septoplasty Discharge Instructions
Adenotonsillectomy (Tonsils) Discharge Instructions
Ear Tube Discharge Instructions
Wound Care Instructions (for patients with Steristrips)
Wound Care Instructions (for patient without Steristrips)
