Patient FormsAt Digestive Center of the Palm Beaches, your time is as valuable to us as it is to you. That’s why we provide online access to a variety of forms that patients may complete before their visit. The following documents will help us expedite the check-in process for your appointment. Please take a moment to download and print the appropriate form(s).
Patient Information Notice of Privacy Practices & Consent Notice of Privacy Practices (Spanish) Assignment of Benefits Patient Rights and Notification of Physician Ownership Medical History Medication List Credit Card Information
At the time of your visit, patients need to provide our office with the correct insurance information, including your insurance card to be copied. We ask that all co-insurance and deductibles be paid at the time the service is performed. We will perform courtesy billing for you, provided you have given us all pertinent billing information.
Your insurance coverage is an agreement between you and your insurance company. Financial responsibility rests with the patient for deductibles, co-insurance and non-covered services. In addition to cash and personal checks, we accept Visa, MasterCard, Discover, and debit cards. If you have an HMO policy, you must have referral to be seen by our doctors.
You may receive a separate bill for anesthesia, pathology, and labs. When procedures are performed, a biopsy specimen may be sent to a lab to be analyzed. The fee for this is a separate charge from your office services. Your payment for this lab service should be sent directly to the lab.
Our contracted insurance plans include:
• Blue Cross & Blue Shield
• Champ VA
• Dimension Health
• First Health/Affordable
• Great West Healthcare
• Medicare Part B
• Tricare-Humana Military
• United Healthcare
• Vista Health Plan