All new patients should review and complete our New Patient forms. You must bring the signed originals with you to your appointment.
Notice of Privacy Practices
New Patient Paperwork
Dr. Sampat New Patient Paperwork– New patients seeing Dr. Sampat, please fill out these forms instead of the general New Patient Paperwork.
Dr. MacGillis New Patient Paperwork– New patients seeing Dr. MacGillis, please fill out these forms instead of the general New Patient Paperwork.
- Completed New Patient forms
- Driver’s license/State ID
- Insurance card
- Copay – All copays are due prior to seeing the provider. If you are unable to pay your copay, unfortunately your appointment will be rescheduled.
- Referral from your primary physician, if needed—All HMO patients are responsible for getting their referrals/authorizations from their primary care physician. If you do not have your referral at the time of your appointment, it will be rescheduled.
- Any x-rays or MRI films related to your injury/condition
Please note, all of our Physicians do not participate in all insurance products. Please check with our scheduling office when making your appointment.