 New Patient Forms
Dear New Patient,
Thank you for choosing Green & Urribarri, LLC. It is our every desire to provide you with excellent and timely service. The following guidelines were designed to facilitate this process.
ON THE DAY OF YOUR APPOINTMENT:
• Please complete the NEW PATIENT FORMS and bring completed to your appointment. A map with directions to our office located here for your convenience.
• Please arrive 15-20 minutes prior to your scheduled appointment time. This will allow us to complete the registration process in a timely manner. Please note that arriving late may result in your appointment being rescheduled.
• Please bring your current insurance card to every appointment. If your insurance requires prior authorization/referral, we will need to have this on file before you can be seen. If you arrive for your appointment and we cannot verify your insurance coverage or authorization, you may pay in full at the time of the visit or reschedule your appointment.
• Be prepared to pay your co-payment or deductibles at every visit. Your co-payment amount is normally indicated on your insurance card. For your convenience our office accepts checks, cash, and all major credit cards.
• We will make every effort to accommodate your scheduling needs. In return, we ask that you help us by keeping your scheduled appointments or by notifying us at least 24 hours in advance if you are unable to do so. A charge will be made for ALL broken appointments in the amount of $40.00 unless a 24 hour notice is given.
Please fill out the attached forms and bring them with you to your visit.
Thank you for your cooperation. We are looking forward to being of service to you and your family.
New Patient Forms
Pre Admission Information
Coral Springs Medical Center
Northwest Medical Center
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