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Self-Pay Pricing

First-Time Patient Visit: $100

Follow-Up Visits: $75

DOT Physical: $125

New Patients Welcome

Walk-ins and new patients are welcome daily. No referral is needed.

Most Insurance Accepted • Self-Pay Available.

What to Bring

Please bring your medications, any available medical records, vaccine card, photo ID, and insurance card.

New Patient Intake Form

If you are a new patient, please complete the form below before your first visit. This helps our team review your information ahead of time and makes check-in quicker and easier.

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*Please complete all required fields and submit the form when finished.

Please Complete All Entries

DOB
Month
Day
Year
Sex
Male
Female
Multi-line address
Marital Status
Single
Married

Insurance Information

Do you have Insurance?
Yes
No
Do You Have Secondary Insurance?
Yes
No

Payment Policies

  • You are financially responsible for any charges your insurance does not cover. All copays are due and payable at each visit. The amount your insurance allows and pays, as well as your financial responsibility, is determined by your insurance company and the policy you have chosen. Your claim will be processed according to the benefits of your insurance plan. Any deductible, coinsurance, and copay are your financial responsibility. It is your responsibility to understand your insurance plan and its benefits.

  • A $5 fee will be charged for copays not paid at the time of service.

  • A $20 no-show fee will be charged for missed appointments that are not canceled or rescheduled at least 24 hours prior to the scheduled appointment time. Please be considerate of our staff and other patients by calling at least 24 hours in advance if you are unable to keep your appointment.

  • A $35 NSF fee will be charged for any check returned by the bank due to insufficient funds.

  • If you are a private-pay patient without insurance, all charges are due at the time of service. We do not send statements to private-pay patients.

Prescription Policy

  • Please do not wait until you have taken your last pill to request a refill. Prescription refill requests require up to 72 hours for processing. If you have not been seen by the provider within the past 6 months, your refill request may be denied and an appointment may be required.

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