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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. Out of respect to other patients, and because of our desire to see patients in need in a timely manner, we request 24 hour notice if you must cancel an appointment. A $25 charge will apply if you miss an appointment without notifying in advance. 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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