Patient Center

Online Bill Pay

ONLINE BILL PAY available via MY CHART!
Contact the office today to set up your My Chart Account.

Patient Forms

Before you come in for your visit, please download and fill out the following forms:

• Patient Registration
• Health History
• Insurance Assignment/Financial Agreement
• Office Policy
• PHI Disclosure
• HIPAA/Notice of Privacy Practices

Other Forms:

• Medical Records Release
• Self Pay Policy

We ask that you arrive 15 minutes prior to your scheduled appointment to complete your registration.

For your appointments you will also need to bring the following:

1. All forms printed and filled out
2. Please bring your current medications or your most UP TO DATE medication list
3. Co-pays are due at the time of service. We accept VISA/MasterCard, personal checks, debit cards, or cash.
4. Insurance cards and referral
   (if required by your insurance company)
5. Photo ID
   (Please give Receptionist your Insurance cards and Photo ID upon your arrival)

Our office requires at least 24 hours advance notice if you are not able to keep your appointment with us.

Patient Portal

Check out our new secure MyChart: https://mychart.acumenmd.com/