New Patient Packet Download

Dear New Patients:

If you have been scheduled to be seen in our office in the near future. You will be receiving a new patient packet that needs to be returned prior to your office visit, this will expedite the check in process. In the near future you will be able to complete forms via the NEXTMD portal.

If you did not receive the packet please download, print and fill out before you come.

If a Minor and/or Dependent Adult is scheduled and you are not attending the appointment with them. All appropriate forms must be signed by person(s) with legal authority to sign for medical treatment and financial distribution. If you have P.O.A. or Legal Guardian you must provide us with copies to validate your right to sign, or your signature will not be accepted.

To provide accurate and efficient medical treatment, we will be requesting all of your pertinent medical records. We may need a signed release to obtain, if this is not included in your packet and you have knowledge of records we may need, please contact scheduling and we will send you the appropriate releases’s. You may also contact the rendering facility yourself and request that your records be forwarded to our facility.

Our physicians review MRI’S and CT’S on disc, please obtain a copy prior to your appointment. Scans done at Genesis facilities, Metro MRI facilities, Advanced Imaging, Unity Point Health(Trinity), Cottage Galesburg Hospital and ORA Imaging will be reviewed on line therfore you don’t need to obtain. Scans must be obtained to ensure the physician can accurately diagnose your condition and not duplicate testing. Your disc(s) will be returned to you after reviewed to keep with your medical records.

Please bring a current medication list if not included in your packet. If you need assistance, please contact your pharmacy as they will provide a list for you. The physicians must know exactly what  medications you are to accurately evalute your condition and prescibe new medication if necessary.

If you have a friend or family member assisting you with your medical care, it may be beneficial to have them attend your appointment with you. They may be able to provide additional information on your condition. This information enables our physicians to make an informed decision when recommeding a treatment plan. We appreciate all of your effort prior to your appointment, we look forward to meeting you.