To expedite your appointment and save you time in the office, we have provided our patient forms below. Please print and complete each form before your appointment and bring the forms with you to your appointment.
Complete Forms Packet
- Patient Forms Packet (12 pages)
- Patient Information Form
- Medical History Form
- Consent Agreement
- Authorization to Use and Disclose Health Information
- HIPAA Notice-of-Privacy-Practices
- HIPAA Acknowledgement Form
Specific appointment times are made for the convenience of both you and the physicians. While every effort is made by our physicians to keep to the appointed schedule, the nature of medical practice is such that unexpected emergencies do occur, which may delay us. Rest assured that when you become acutely ill, we will also make time for you.
Arrive 5-10 minutes before your appointment so insurance matters can be addressed by the receptionist. Please bring your insurance card on every visit. If you must cancel an appointment, call the office at least 24 hours in advance so that the time can be released to another patient.
Billing & Insurance
We accept assignment on all Medicare patients. We accept many of the managed care health plans currently on the market. Payment for services is expected at time of service, and as a courtesy we will be glad to file your insurance for you.
Effective January1, 2018, The Kaufmann Clinic accepts Kaiser Permanente through the Public Exchange. If you have questions, please contact our office.
Medical records are the property of the clinic. Contents are private and are released only with written consent of the patient. When consultations are done for other physicians, a written report of our findings is forwarded to the referring physician.