New Patients


 

Physician Referrals

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

Patient Forms

Medical History Form

Appointments

To expedite your check-in and keep waiting times to a minimum, we ask that new patients show up 15 minutes before their appointment. This allows for processing necessary administrative information or filling out forms.

What should I bring to my appointment?

  • Your insurance card and driver's license - A copy of your insurance card will be requested at the time of check-in. Your driver's license is required for patient identification.
  • Shorts or a tank top - Our evaluation includes thorough examinations on every patient, so it helps to have good exposure of the joint or extremity being examined. Please bring appropriate clothes to change into, to allow for adequate evaluation.
  • X-rays and other details pertinent to your orthopedic problem - 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.

Appointment Cancellations

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

  • Any established patient who fails to show or cancel an appointment and has not contacted our office 24 hrs. prior will be considered a No Show and charged a $25.00 fee.
  • Any new patient who fails to show or cancel an appointment and has not contacted our office 24 hrs. prior will be considered a No Show and charged a $45.00 fee.
  • After a third No Show should occur the patient may be dismissed from Sports Medicine Center.
  • As a courtesy, reminder calls/texts for appointments are sent to you prior to your scheduled appointment.

Insurance & Billing

Insurance Forms

Our office will complete health insurance claim forms on the patient’s 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, requires a referral in order for the patient to be seen in our office, it is the patient’s responsibility to obtain the referral prior to the appointment. If worker’s 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.

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.

Billing Department

Please contact our office at (920) 993-1643 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.

Policies

Prescription Refill Policy

Medication refills are done during working hours. Please call the office and allow 24 hours for routine refills. Refills after hours and on weekends are done only for emergencies and are considered individually.

Patient Privacy / HIPAA Policy

Download a PDF document containing our patient privacy and HIPAA policy

Patient Privacy

Location
Sports Medicine Center
277 Altenhofen Drive
Appleton, WI 54913
Phone: 920-212-3609
Fax: 920-993-1645
Office Hours

Get in touch

920-212-3609