New Patient Forms
Rochester RHIO form – This authorization allows us to access medical records and health information from other health care facilities tied to RHIO. It is the patient’s decision to share these records or deny access. Download
Patient Financial Policy – Our financial policy is crafted to prevent patients from being surprised about their financial obligations when they receive services. We have designed this policy to reduce confusion and misunderstanding between the patient and provider. If you have any questions regarding these policies, please discuss them with our billing department or office manager. We are dedicated to providing the best possible care and service to you and regard your complete understanding of your financial responsibilities as an essential element of your care and treatment. Download.
No Surprise Billing Act – A surprise medical bill is an unexpected bill, often for services received from a health care provider or facility that you did not know was out-of-network until you were billed. Your health insurance may not cover the entire out-of-network cost which leaves you owing the difference between the billed cost and the amount your health insurance paid. This is known as “balance billing.” This bill could be for a service like anesthesiology or laboratory tests. You may not know that the provider or facility is out-of-network until you are billed. Download