Please print and complete the following forms prior to your first visit to Nephrology Associates. Filling out these forms ahead of time will help save time when you come for your appointment.
- New Patient Information Form
- Health History Form
- Patient Guarantee Form
- Notice of Privacy Practices
- Authorization for Release of Medical Records
- Office Visit Cancellation Policy (Coming Soon)
We are committed to providing the highest level of medical care to our patients. To ensure that our patients fully understand our billing process, we ask that you read and sign the form listed below.
- Eligibility Guarantee/Patient Financial Responsibility (Coming Soon)
Patients are seen in the office by appointment only. Please call (850) 474-8121, option 1 to make an appointment. For your initial visit, we request you to download and fill out the forms in the Patient Forms section above. If this is not possible, please arrive in the office fifteen minutes early to fill out necessary paperwork.
Cancellation/No Show Policy for Doctor Appointment
We normally make a courtesy confirmation call to remind you of upcoming appointments. We have a 24-hour phone message system with a voicemail attendant so that you may conveniently and promptly cancel appointments that you are unable to keep.
We consider any cancellation made less that 24 hours prior to your scheduled appointment a short-notice cancellation since this makes it difficult to schedule another patient to fill the appointment time that had been reserved for you. If you do not keep a scheduled appointment and fail to notify us in advance, or if you notify us with only a short notice as defined above, we will impose a $50.00 charge against your account.
Thank you in advance for your understanding. We hope that this policy will help serve all of our patients promptly and efficiently.
We contract with many insurance plans and accept cash, check, Mastercard, Visa, and American Express. Payment of all Co-pays and Deductibles must be made at the time of all visits. If we do not participate with your insurance company, full payment is expected at the time of any office visit. In addition to Medicare, we accept most private insurances that are non HMO.
- American Association of Kidney Patients (AAKP)
- American Kidney Fund (AKF)()
- American Society of Pediatric Nephrology (http://www.aspneph.com/)
- National Kidney Foundation (NKF)
- Dialysis & Transplantation
- Renal Info
- Hypertention, Dialysis, and Clinical Nephrology (HDCN)
- Kidney & Urology Foundation of America
- Kidney School
- Life Options Rehabilitation Program
- Kidney & Urologic Diseases
- Nephron Information Center
- Nephro World
- Renal Support Network
- U.S. Renal Data System (USRDS)
- American Diabetes Association