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If you are a first-time patient of Piedmont Otolaryngology:You can save time by printing and filling out these forms in advance of your visit.
Financial Policy:Please bring your insurance card at the time of your visit so that we may submit claims on your behalf to your insurance company. If your agreement with your insurance requires a referral, please confirm with your primary care physician that the referral is sent to Piedmont Otolaryngology in advance of your visit. All co-payments and deductibles as determined by your agreement with your insurance company are due on the day of your visit. We accept cash, check, Mastercard, and Visa. |
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Forms are in
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199 Spotnap Road, Suite 5 • Charlottesville, VA 22911 • (434) 220-0045 • (434) 220-0065 (fax) |
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