Information/Insurance Plans/Forms
FORMS
PATIENT REGISTRATION 2020 4pgs
For the Doctor
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Insurance card
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Photo ID
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Copay: we accept cash or check ONLY
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Current Medications: This may also be a list including dosage and quantity taken daily.
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List of questions to prepare for your appointment.
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Cancellations must be made 24 hours before appointment time or patients will be subject to a $30 cancellation fee.
For the Registered Dietitian
1. Please bring the following forms filled out to your first visit:
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– New Patient Basic Consult
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– Patient MNT Release Form
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– Cancellation Policy
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– HIPPA Privacy Practices Summary & Acknowledgment for Nutrition Services at the Medical Art Center
2. Food Journal One or more weeks worth – Not required but very helpful!
3. Vitamins/Minerals/Supplements
4. Foods/articles you have questions about – Not required
5. List of questions to prepare you for appointment – Not required but helpful
There are 2 ways you can bring a food journal:
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Create a Login and Password on the website: My fitnesspal.com (also can access on your cell phone) and bring your login and password to the visit
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Write in a notebook- Please include portions of food eaten, beverages, time you ate and place.
Also include physical Activity
72 hour cancellation policy or a $100 fee will be charged
*DOCTORS HOURS/OFFICE HOURS are subject to change during the month of May and June*
DOCTORS HOURS
Monday 9-5
Tuesday 12-8
Wednesday 9-3
Thursday 9-3
Friday Emergency Only
Saturday Call To Confirm
OFFICE HOURS
Monday 9-5
Tuesday 12-8
Wednesday 9-3
Thursday 9-3
Friday 9-1
Saturday Call To Confirm
Health plans which we accept:
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Aetna
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Amerihealth
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Blue Cross Blue Shield
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Cigna
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Empire Blue Cross Blue Shield
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Highmark Blue Cross Blue Shield
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Horizon Blue Cross Blue Shield of New Jersey
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Locals (any local)
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Oxford Health Plans
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QualCare
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United Healthcare Basic Plan
Not covered by any of these plans?
Contact us and we will find the best solution to suit you.