Medical Forms

Adult Intake


(1-5 Years)

(6-19 Years)

Balance Evaluation

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Insurance, Billing & Payment

We are committed to building a successful relationship with you. We strive to be transparent in all matters and having a clear understanding of our Patient Financial Policy is important to our professional relationship. 

Our office charges are based upon the nature of the presenting symptoms, time involved with each patient, and the services rendered during an appointment.  As you are financially able, we believe that patients should bear the responsibility for their own healthcare costs through both insurance and private pay resources. We also believe that no person in our care should go without needed services due to financial hardship. Our goal  is to provide quality care and have healthcare resources available to meet your needs.  Patient Financial Policy

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We accept most major medical insurance including: Blue Cross Blue Shield, United Health Care, AETNA, Medicare and Medicaid.

Credit Card, Cash & Personal Check

We accept most major credit cards including Visa, MasterCard, and Discover, in addition to cash and personal checks.


To ensure financial considerations are not an obstacle for you to receive the best care possible, we offer financing through . This is a payment option specifically for healthcare needs costing over $200.00. It offers low minimum monthly payments and no up-front costs or pre-payment penalties. Apply online.

Payment Policy

Our expectation is that you pay for non-covered services at the time of your visit, in addition to when receiving a statement. If you are unable to pay your balance, please contact our billing specialist to discuss payment options in order to have a mutually agreeable payment schedule in place. Patient Financial Policy