Information/Insurance Plans/Forms

FORMS

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PATIENT REGISTRATION 2020

ANNUAL PHYSICAL FORMS 4 PGS

ULTRASOUND PREPARATION

MAC WEIGHT MANAGEMENT

Please email request to MedicalArtCenter950@gmail.com 
include:
completed registration (2 pages),
front pic of a current ID,
insurance card ​and contact number.

COVID REGISTRATION FORM PDF
COVID REGISTRATION FORM docx

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For the Doctor

1. Insurance card

2. Photo ID

3. Copay: we accept cash or check ONLY

4. Current Medications: This may also be a list including dosage and quantity taken daily.

5. List of questions to prepare for your appointment.

6. 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:

• – New Patient Basic Consult

• – Patient MNT Release Form

• – Cancellation Policy

• – 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:

• 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

• 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

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OFFICE HOURS
Monday 9-5
Tuesday 12-8
Wednesday 9-3
Thursday 9-3
Friday 9-1
Saturday Call To Confirm

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Health plans which we accept:

• Aetna

• Amerihealth

• Blue Cross Blue Shield

• Cigna

• Empire Blue Cross Blue Shield

• Highmark Blue Cross Blue Shield

• Horizon Blue Cross Blue Shield of New Jersey

• Locals (any local)

• Oxford Health Plans

• QualCare

• United Healthcare Basic Plan

Not covered by any of these plans?
Contact us and we will find the best solution to suit you.