Sports Medicine Center
Patient Information

Patient Reminders

PCP referral
Please review your insurance policy requirements to determine if you need a referral from your primary care physician prior to visiting us.

Insurance information
Please remember to bring your insurance card to your appointment. A copy of your insurance card will be requested at the time of check-in.

New appointments
In order to expedite your check-in and maintain waiting times to a minimum, we ask that new patients show up 15 minutes before their appointment. This allows for processing necessary administrative information and fill out forms.

Patient Forms

Online Patient Forms

Past Medical History

Downloadable PDF Patient Forms

Past Medical History

Appointment cancellations
We request that appointments be cancelled no later than the day prior to the scheduled visit, in order to give other patients an opportunity to be scheduled on your cancelled time slot.

Bring shorts or tank top
Our evaluation includes thorough examinations on every patient. This is facilitated by good exposure of the extremity being examined. Please bring appropriate clothes to change into, to allow for adequate evaluation.

Additional material pertinent to your orthopedic problem
Please bring all pertinent X-rays, operative reports, other clinic notes, and therapy notes when other providers have rendered previous evaluation or treatment. All this additional information can be of importance in your evaluation.

Appointments may be made by calling 920-993-1643 between the hours of 8:00 a.m. - 5:00 p.m. Monday through Thursday and 7:00 a.m. - 3:00 p.m. on Fridays.

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Prescription Refill Policy
Routine medication refills are done during working hours, Monday through Thursday, between 8:00 am - 5:00 pm and Friday, between 7:00 am - 3:00 pm. Refills after hours and on weekends are done only for emergencies and are considered individually.

Insurance Forms
Our office will complete health insurance claim forms on the patients behalf free of charge. If you are covered by an insurance company that requires pre-certifications or authorizations, it is the patient's responsibility to inform our office. If the patient's insurance company, such as an HMO require a referral in order for the patient to he seen in our office, it is the patients responsibility to obtain the referral prior to the appointment.

If workers compensation is responsible for the services rendered, it is the patient's responsibility to advise the employer to report the claim to their insurance carrier. We will submit claims to the employer if no insurance information is available.

Billing Department
Please contact our office at 920-993-1670 regarding questions about the patient account. Statements are sent out on a monthly basis, showing the current status of the balance due. We will send statements of any balances due from the patient. Those services pending with insurance will not be billed to the patient until a payment has been received from the insurance company, or deductibles have been applied, and the services become the patient's responsibility.

Financial Policy
There is a fee charged for office visits and consultations in the office as well as follow-up visits when indicated. A charge may be made for any additional services provided such as x-rays, dressings, casting, braces, etc. Patients without insurance are required to pay at the time of service.

Patient Privacy Rights - HIPPA Compliance
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