|
Paperwork for Adult New Patients
 (20 pages, 297KB)
Paperwork for Teen New Patients
(19 pages, 293KB)
To open and
print these documents you need the freely-available Adobe Acrobat Reader
 .
Included in this paperwork are the following forms: Introductory
letter, map, email form, patient registration form, patient health
questionnaire, sleep questionnaire, Beck inventory, sleep diary, assessment of
patient behavior by bed partner, authorized representative form, and insurance
form.
APPOINTMENTS:
We work by an appointment
system, with one or more of the doctors in the office each day. In-depth sleep
and general health questionnaires and a sleep diary of sleep and awake times
are completed before the first visit. These are reviewed at the time of the
initial evaluation and provide important information to the doctor.
If you need a referral from
your primary care physician, please make sure that you bring this at the time
of the appointment, or that our office has it before your scheduled
appointment. Your promptness in keeping appointments is appreciated. Please
call ahead if you will be late or require any change in appointment
times.
Rarely does our Texas
weather preclude opening the office. If ice or snow is on the streets, please
listen to the area school closings. If Fort Worth Independent School District
is closed, the Fort Worth office will also be closed. If there are any
questions, please call the office before keeping an appointment if the weather
is questionable.
PHONE
POLICIES:
NON-EMERGENCIES: For
non-emergency calls, you should contact the office during regular office hours
(9 a.m. to 4 p.m. week days). Questions and concerns should be described
briefly so the appropriate staff will be notified and return your call. Please
do not wait until 4:30 on Friday evening to call if you are having
problems.
EMERGENCIES: One of the
doctors is on call for emergencies and may be reached by dialing the office
number, 817-332-7433. If your emergency occurs during the working hours, it
will be triaged by the staff; they will contact a doctor promptly and await
instructions; you will be called as soon as instructions are received. After
hours your call will be forwarded to the answering service. The on-call doctor
will be notified and will call you as soon as possible. If your emergency is of
adequate concern to you or your family, dial 911 or go to the emergency
room.
SMOKING:
Smoking is NOT allowed
within our office or in the sleep laboratories.
FINANCIAL
POLICIES:
We accept most insurance
assignments including Medicare; however, co-payments for each office visit are
due at the time service is provided. Benefits are verified prior to scheduling
of sleep studies (nocturnal polysomnograms) and you will be notified of the
findings. We would request your assistance with any problems that may arise
concerning policy limitations, coverage limits, or nonpayment.
You are encouraged to ask
questions and obtain information concerning your charges. Statements are
provided on a monthly basis. We accept MasterCard, Visa, American Express and
Discover cards, cash and personal checks on all outstanding balances.
PRIVACY POLICY
|
