YOUR FIRST VISIT CHECKLIST
When to Arrive
- When you first arrive at our offices for a doctor visit, please check in at the front desk and bring the following items with you:
- Health Insurance card of patient
- List of current medications
- Photo Identification of the Responsible Party (self or parent/guardian)
- Any referral form(s) that patient has received from primary care physician, ER, etc.
- Any imaging (x-rays, MRIs, CT scans, etc.) you have had for this condition. All films or picture cd’s taken need to be hand carried to your appointment.
- Workers Compensation claim information (if applicable)
- Motor Vehicle Claim Information (if applicable)
- Please keep in mind we do not bill third party insurances.
- We will set you up as a self pay and you may forward the bills accordingly.
New Patients and ER Referrals
If you have been referred to us through the ER or have not previously been seen by any of the providers in our clinics, you will need to read, complete, and submit the following information when you arrive:
New Patient Registration
- Referring physician information required
- Workers Comp Injury form (if applicable)
- You will fill out your Patient Registration Information forms upon arrival, or download the form and complete in advance.
- Please have a current medication list available.
- Notice of Privacy Practices (HIPAA) You will fill out your Assignment of Benefits and Direction for Payment and Assignment and Lien for Medical Services Rendered.
Co-Pays and Other Payments
- Your co-payment is required at the time of service
- We accept Visa, MasterCard, American Express, Debit Cards and Checks.
Remember we have three Walk-in Clinics to serve you even better!
In many cases, this service offers patients a quicker and less expensive alternative to the hospital emergency room. No appointment is necessary. Jewett Orthopaedic Clinic is home to three of the country’s first walk-in orthopaedic convenient care centers dedicated solely to treating broken bones, strains & sprains.