Patient Information

New Patients and Patients not seen within the last 6 month year

Once you have scheduled an appointment we will provide you a security code to our PATIENT PORTAL located on this website to complete your patient medical history. Your medical history and HIPPA patient privacy form must be updated every 6 months. To save time in our waiting room please use this option. If you have any difficulty with it, please call our office 517-264-5603 and one of our staff members will assist you.

If you prefer to download the form at home and bring it with, please select medical history form and bring it to your appointment.

NEW PATIENTS: PLEASE DOWNLOAD OUR PATIENT MEDICAL HISTORY FORM:

New Medical History Form 2014

 

However, if you do not have this information completed prior to you appointment you must arrive 15 – 20 minutes prior to your scheduled appointments.

All Patients:

Payment for services is expected at time of service.

Dr. Desjarlais does participate with the following insurance companies. It is your responsibility to know if you need prior authorization, what your deductible is and also your co-payment. If you need prior authorization and do not have it at time of your scheduled appointment, we will not be able to see you on that date. Please let us know if you have any insurance questions prior to your appointment.

> Aetna
Blue Cross Blue Shield PPO
Blue Cross Blue Shield Traditional
Blue Care Network (HMO Referral Required)
Cigna
Cofinity (formerly PPOM)
Front Path Health Coalition
Health Net Federal Service, (Champus /Tricare)
Humana Medicare
Paramount
Priority Health
Private Healthcare Systems (PHCS)
United Health Care (non Medicaid)

The day of your appointment PLEASE BRING

All Medical Insurance Cards
Driver’s license or legal photo id
Complete list of all your current medications
If patient is a minor, a parent or legal guardian must accompany patient and have proper documents. Please see forms to download if you do not have your own.
Primary Care Physician Referral (if required)

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Payments, Services, and Insurance

Co-payments and deductibles are due at the time of treatment. As a courtesy to you, our staff will submit a bill to your primary health insurer and secondary, if applicable, for treatment. Payment for all treatments not covered by insurance is expected at the time of service.

Upon payment of insurance our accounts receivable staff will mail you a statement that will contain the total cost of your service(s). You should expect this bill within 30 days. Your health insurance action or payment will be noted on this statement when it is received. We want to ensure you understand your insurance and ask that you contact us with any questions you may have about your account.

Balances due are expected within 14 days of receipt of statement. Any balances past 90 days will be subject to late fees of $25.00. Any account over 100 days past due will be subject to our collection process.

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We accept all major credit cards and Care Credit.

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CareCredit is a healthcare credit card similar to other major credit cards. However, CareCredit is unique in that it offers No Interest Payment Plans (if paid within the promotional period; minimum monthly payments are required). CareCredit also offers Extended Payment Plans with low fixed Interest. In addition to using your card at our office, you can use it at other healthcare practices that offer CareCredit, like your dentists office. You can find out more information and/or apply for CareCredit at our office or by phone at (800) 365-8295. You may also click on the CareCredit logo above to apply.

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Cancellation Policy and Late Arrivals

You will receive a call, email , or text confirming your appointment time. If you are not able to make your appointment we ask that you call us in advance as soon as possible to cancel or reschedule. If you arrive 15 minutes past your appointment time we will have to reschedule your appointment.

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Medical Records and Release Forms

We are pleased to comply with all requests to release copies of our medical records. To request your records please download the following forms based on your specific need.

All Forms:

Patient Registration
Medical History
HIPPA Patient Privacy Form
Records Release TO US
Records Release FROM US
Consent to treat Minor

If forms were mailed to you or if you download and of the forms above please mail them back as soon as you complete them to assure they arrive before your appointment

VIEW THE HIPPA NOTICE OF PRIVACY PRACTICES