Forms
If you are a new patient, you can download the paperwork directly from the link below. Bring them with you on the day of your appointment for your added convenience.
Click here to download our patient information form.
Click here to download the HIPPA form.
Office Policies
Insurance Information - Co-payments and Deductables
Payment is required for all services at the time they are rendered. All applicable co-payments will be collected at the time of service. Deductibles will be billed to a patient upon receipt of explanation of benefits from insurance. An administrative billing fee of $10 will be applied if co-payments are not paid at the time of service. In the event that the patients account must be turned over for collections, interest and/or a collection fee, at the provider’s current rate, may be charged on all balances owing to the provider that are past due.
Selection of Primary Care Provider (PCP)
If PCP selection is required by patients insurance plan, it is patients responsibility to select Dr. Kahyaoglu as PCP and assure it is completed at the time of my visit.
Insurance Cards
New patients or those patients with a change in their insurance information must provide a valid insurance card or temporary print out at the time of the visit. Should you be unable to produce this documentation, patients may pay in full at the time of service and submit the claim to your insurance carrier at your convenience for reimbursement.
If you are a new patient, you can download the paperwork directly from the link below. Bring them with you on the day of your appointment for your added convenience.
Click here to download our patient information form.
Click here to download the HIPPA form.
Office Policies
Insurance Information - Co-payments and Deductables
Payment is required for all services at the time they are rendered. All applicable co-payments will be collected at the time of service. Deductibles will be billed to a patient upon receipt of explanation of benefits from insurance. An administrative billing fee of $10 will be applied if co-payments are not paid at the time of service. In the event that the patients account must be turned over for collections, interest and/or a collection fee, at the provider’s current rate, may be charged on all balances owing to the provider that are past due.
Selection of Primary Care Provider (PCP)
If PCP selection is required by patients insurance plan, it is patients responsibility to select Dr. Kahyaoglu as PCP and assure it is completed at the time of my visit.
Insurance Cards
New patients or those patients with a change in their insurance information must provide a valid insurance card or temporary print out at the time of the visit. Should you be unable to produce this documentation, patients may pay in full at the time of service and submit the claim to your insurance carrier at your convenience for reimbursement.