Patient Information



A Word About Payments:

All professional services rendered are charged to the patient. Necessary forms will be completed to help expedite insurance carrier payments. However, the patient is responsible for all fees, regardless of the insurance coverage. It is customary to pay for services when rendered, unless other arrangements have been made in advance with the office manager.

If you need to cancel or reschedule your appointment, it must be done 24 hours (or more) in advance. If you do not notify the office 24 hours (or more) before your scheduled appointment, you will be charged a no-show fee of $40 (for the office visit) or $200 (for the procedure.)


  • The right to impartial access to treatment, regardless of race, religion, gender, sexual orientation, ethnicity, age, or disability.
  • The right for the patient, or his/her representative, to be fully informed in advance, and to make informed decisions about care or treatment and to actively participate in the planning of his/her care.
  • To receive appropriate privacy, confidentiality and security concerning you and your medical care. Every effort will be made to maintain your privacy during all phases of your stay.
  • The right for the patient to receive care in a safe environment and to be actively involved in the safety strategy.
  • The right to be free of all forms of abuse or harassment, restraint or seclusion.
  • The right to know that all advanced directives and CPR directives are suspended during the procedure.
  • The right to refuse treatment and to be informed of the consequences of your actions.
  • To know if any research will be done during treatment and the right to refuse.
  • The right to be given the opportunity to participate in decisions involving your care, treatment and services, including pain management, except when such participation is contraindicated for medical reasons.
  • The right to know the professional status of all persons providing your care. All staff will introduce themselves to patients and family and states their status, i.e., RN, Endotech, MA.
  • The right to access information contained in his/her medical records. Upon WRITTEN request, a copy of the patient’s medical record can be provided for a fee.
  • The right to confidentiality of his/her medical records maintained by the facility. Access to the medical records shall be limited to the patient, individuals directly involved with the patient’s care, individuals monitoring the quality of patient care, and those individuals authorized by law or regulatory agency.
  • To know the methods for expressing privacy concerns, grievances, and suggestions to the facility including external appeals as required by state and federal regulations.
  • Upon request to know, in advance, the estimated amount of your bill.
  • Upon request to examine and receive an explanation of the final bill, regardless of the source of payment.
  • To have the right to be informed of the mechanism by which you will have continuing health care following discharge from the facility (discharge instructions).
  • The right to be informed of the need for his/her transfer to an outside facility for a higher level of care that is not provided at this facility.