Policies & Forms

To ensure your visit is smooth and efficient, please review the important instructions and complete the downloadable forms provided below before your appointment.

Pre-Visit Instructions

  • Arrive 10–15 minutes early
  • Bring a valid photo ID and insurance card
  • Have your completed forms ready (or email them ahead)
  • Include any relevant imaging or past medical records
  • Bring a list of your current medications and supplements

Policies

Center Policies

Please DO NOT wear cologne, perfume, or scented lotions to the center. If you are 15 minutes late to your appointment, there is a chance that you will be seen by a different provider other than the one that you scheduled with. Keep in mind that appointments that are 15 minutes or more late may have to be rescheduled to another day or time and you be responsible for a fee.

Prescriptions & Refills

Follow-up Required: Prescriptions may not be refilled if you’re overdue for a visit. Follow-up appointments are required at least every 6 months for routine meds and every 3 months for controlled substances.

No After-Hours Refills: Routine prescriptions are not filled after hours or on an urgent basis.

Controlled Medications: Narcotics and sleep aids are only prescribed during office visits. Please plan ahead to avoid running out.

No Shows and Cancellations

We dedicate ample time to each patient by not overbooking. To manage our schedule, please confirm your appointment at least 48 hours in advance. Late cancellations or missed appointments will result in a fee:

  • $75 for follow-up visits
  • $175 for initial visits
  • $200 for testing appointments

Fees will be billed to the patient and charged to the credit card on file.

Emergencies & After-Hours Calls

During regular office hours (Monday through Saturday), call the office for your healthcare issues. For all emergencies outside of office hours, call the office phone number and speak to our operator and or go immediately to the nearest emergency room.

Downloadable Forms

New Patient Intake Form

Download PDF

Authorization for Release of Medical Information
(From Facility)

Download PDF

Authorization for Release of Medical Information
(From MCHN)

Download PDF

Migraine Disability Assessment Test

Download PDF

HIPAA Privacy Notice

Download PDF

Have questions about the forms?