These are the practice policies
Medical Release Form
COVID 19 Informed Consent
Consent to Treatment
Consent to Receiving Practice Policies and Privacy Practices
Notice of Privacy Practices
Nyota Photography Consent Form
Nyota Photography Media Consent Form
Advance Beneficiary Notice of Noncoverage (ABN) – English
Advance Beneficiary Notice of Noncoverage (ABN) – Spanish
Referring to our clinic is very simple.
We ask that you fax the following documents to our HIPAA compliant Fax 980-500-2086.
Once documents are received, we will contact your patient and/or caregivers to schedule an appointment within 14 business days.
If your insurance is not listed, we can provide you with a superbill that has all the necessary information you need to directly submit a claim to your insurance so you can get reimbursed.
Accepted forms of payment: Debit cards, Credit cards and checks. For the safety of our employees being on the road we do not accept cash.