Patient Information
Eric H. Denys, M.D.
What to Bring to Your Appointment
Insurance and Payment Information
Patient Forms
- Valid insurance card
- Physician referral form if required by your insurance
- List of current prescription AND over-the-counter medications you are taking, including dose and frequency
- Information about your medical and surgical as well as family history
- Pertinent past medical records as well as recent reports and test results
Our policy is intended to create a clear understanding of our mutual agreements and financial responsibilities and to reduce the increasing cost of practicing.
We provide insurance billing for your primary insurance company. If you have secondary insurance, we will submit a statement provided the co-payments and deductibles have been met.
We request payment at the time of your visit for the services not covered by insurance, for required co-payments, and deductibles. Payment can be made in cash or by check. Visa and Mastercard are accepted. If we cannot be certain about our contractual arrangement with your insurance company, the office requires payment at the time of the first visit. This will allow us to focus on your health needs while working out the details of your insurance arrangements as soon as possible. For subsequent visits we will accept direct payment from your insurance company, once we have been able to establish the contractual obligations, required co-pays, and deductibles.
We accept patients on referral from another physician. We have contracts with Medicare and several PPO plans including Blue Shield,
If you have questions regarding which insurance plans we have contracts with or billing concerns, please call us. Questions regarding your coverage and benefits should be directed to your employer or insurance company.
To save time, please take a moment to print and complete the following Intake History form prior to your initial office visit. You must have Adobe Acrobat Reader™ installed on your computer to access the form. The free version is all you need.
When viewing the form in Adobe Acrobat Reader™, the text might appear somewhat fuzzy; this is normal (the form will print out clearly). To print, simply click on the printer icon in the Adobe Reader tool bar above the document.
Once you have the Adobe Acrobat Reader™ installed, click on the link below to view and print the form.
Notice of Privacy Practices for Eric H. Denys, MD
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
