Patient Forms & Billing


For your first appointment

New Patient Forms

If you are scheduling your first appointment at Healing Hearts Clinic, we request that you bring the following:

  • Proof of insurance
  • Driver license or identification card
  • A list of current medications, including over the counter medications and supplements, to include dose and frequency
  • Medical/Surgical history

Financial Policy and Authorizations Forms

Appointment cancellation

Please call the office to cancel and/or reschedule your office visit appointment. If you are scheduled for a diagnostic study please call the office within 24 hours to cancel. Healing Hearts reserves to right to bill you $50 for each no show or late cancellation. The fee is patient responsibility and will not be billed to your insurance. 

Billing and Insurance

It is our goal to obtain the most recent and up to date insurance information about your plan prior to your visit. However, it is the responsibility of the patient to understand the limits of your policy with regards to physicians seen or services provided.

Our office will submit claims to your insurance company with the information provided for services. You will be responsible for any copays, coinsurance and/or deductibles. It is the policy of Healing Hearts Clinic to collects these monies at the time of visit. 

Telephone Procedures

During office hours, your calls will be answered by our staff. If the person you are trying to reach in unavailable or in clinic, please leave a message and your call will be returned by the appropriate staff member. Please do not leave multiple messages as this will only delay a response.

In case of an emergency, please call 911 or go to the nearest Emergency Room. After hours, calls are routed through the Answering Service to the Physician on call.

Medical Records

If you need to request medical records, our office will provide you with a Medical Records Release form in which you will need to provide the name, address, phone and fax number of the physician and/or office in which they will be sent. Please allow 5-10 working days to complete. Fees may apply.

Prescription Refills

If you are in need of a prescription refill, please contact your pharmacy at least 3 working days in advance and the pharmacy will forward a request to our office. Some prescription refills may require a follow up office visit and please allow 48 hours from the time we receive the request from the pharmacy. Contact your pharmacy to verify refill has been completed. 


Our Locations

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