Please fill out the following forms on our secure portal accessible by clicking on blue link below:
1. Patient Registration Form
2. HIPAA, Telemedicine Billing Policies
3. Medical Questionnaire
4. Medical Review of Systems - Long
In addition there are other forms for either chronic pain , opioid detox or medical marijuana; so please only fill out those forms based upon your underlying condition. Please click on the bar below to start. Once we receive the forms, a member of our staff will contact you within two business days. To expedite there is a quick contact us form that you may use, please also tell us the primary condition you want treated on that form.
all open Workers' Compensation and auto (personal injury) insurance claims - even from NY, NJ, or other states provided the claim is open and we get the correct information and you live in, or can come to treat in Pennsylvania
We can see you if you have out-of-network benefits. Sadly, Obamacare makes it hard to deliver quality medicine at the in-network rates for a specialist, and most pain care is subject to a huge deductible. We can often arrive at fees that fall under the deductible. Please register online and our biller can explain.
Due to low reimbursement for specialty care, we do NOT ACCEPT ANY Medicaid plans (which includes PA Access, AmeriHealth, Geisinger and other Products where the State Pays for the coverage).
However, under federal law these Medicaid plans must find you a specialist in 15 days or else they should provide an out of network referral, which they can fax to us. II you want to be seen you MUST contact your Medicaid insurance directly and ask them to provide you with an in-network specialist who has less than a 15 day wait and is NOT more than a 45 minute drive.
Please see download below at
pages 23 and 24 of STATE STANDARDS FOR ACCESS TO CARE IN MEDICAID MANAGED CARE