Please be sure to provide our office with your current health insurance information. We will file your charges with your health insurance company. Please make sure that the physician in our group that you are seeing is on your health insurance plan prior to your visit.
All office copays must be paid at the time of your visit or a $10.00 processing fee will be added to your account. We accept cash, checks, Visa and MasterCard.
Late cancellations or not contacting the office to cancel an appointment prevents us from scheduling patients that need care. Therefore, we reserve the right to charge a fee for cancellations made within 48 hours of the scheduled appointment time, or failure to show for appointment.
Please call our Billing Department at 937-222-7987 if you have any billing questions.
New Patient Forms
Please print, complete and bring with you the day of your appointment.
Financial Disclosure Forms
To request a discount on your service due to financial hardship, please print, complete and bring with you the day of your appointment.
Doctor Referral Forms
Please print, complete and fax to 937.222.1436.