INSURANCE REFERRALS: Please have necessary referral forms with you at the time of your appointment. If required by your insurance such as HMO and managed care plans. Please arrange this in advance with your primary care provider.

INSURANCE CO-PAYS/BALANCES: Please be prepared to pay your copay and account balance at the time of service. If you are unsure of the amount due, please obtain that information prior to your appointment from your insurance provider. Please obtain your account balance information by either checking with the front desk or calling our office. We accept cash, checks, or credit cards. Visa, MasterCard, AMEX and Discover are accepted at our offices.

TARDINESS: We make every attempt to see you as close to your appointment time as possible. The doctors do however sometimes run late due to the nature of specialty practice. Please call if you are running late. If you arrive more than 15 minutes late for your appointment, we will see you if possible. It maybe necessary to reschedule your appointment. Please come prepared for your appointment with all records and paperwork.

MISSED APPOINTMENTS: There will be $50.0 charge for office appointments missed or cancelled with less than 24 hours’ notice. Advance notice of cancellation allows our office to offer the appointment to another patient. Your understanding is very much appreciated.

PROCEDURE APPOINTMENTS: If not cancelled within 5 business days of the scheduled procedure time, a $300.0 cancellation will be charged. This is so that the appointment may be offered to another patient. This charge is the responsibility of the patient and must be paid before rescheduling your procedure.

MEDICAL RECORD/FORMS: There is a fee for copying or faxing your complete medical record. Please keep any copies of any records you give us for your personal file. We do not provide copies of other doctors’ records to you. Each healthcare provider is responsible to provide those records to you directly. Please ask front desk of fees associated with completing forms, disability applications, dictated letters requested, etc.

Please note: Although medical records are requested on our end prior to your appointment, it is your responsibility to ensure you bring all pertinent records/documents/medical information to your appointment.

PRESCRIPTIONS: Written prescriptions will be provided at your office appointment. If you require a 90-day supply for mail order, please ask the doctor at the time of your appointment Insurance authorization (if required) for medications can take upto a week. To expedite the process, be sure that you have provided current insurance and prescription card information. We sometimes need to change medications to coincide with your plan’s preferred medications. Please allow at least 5 days to process local refills or mail order. Please keep office updated on your medications and your current pharmacy.

I have read and understand the office policies of Gastroenterology Center of Northern Virginia.