Patient Forms

Forms can be completed online through the patient portal or you can print them from our website and bring them with you to your appointment.

Become a Patient

Making an Appointment

Call our office in advance to make an appointment. Be sure to have your health plan member ID card available. If the services for which you are making the appointment require your health plan’s preauthorization, please let us know when you call.

What You Can Expect During Your Visit

When you arrive, we’ll ask you to check in and present your health plan’s member ID card, so be sure to have it with you.

We will ask you to complete the New Patient Registration Form and Notice of Privacy Practices Acknowledgement along with any other forms that may be applicable. To cut down on your time in our waiting room, complete the forms listed above and bring them with you.

Payments and Your Health Plan

We request that you pay for any applicable co-payments, deductible amount and/or coinsurance amount at the time of service. For details on payment options, see our Patient Accounting page.

We will file your claims to your health plan. Typically, your health plan will then send you an Explanation of Benefits or “EOB” detailing your processed claims and any amount that was not covered. Some health plans only make these statements available online, so be sure to check your health plan documentation.

If after your claims process you still owe First Colonial Family Practice and Urgent Care Center a balance, then we will send you an account statement by mail. You can pay your balance by credit card over the phone, by mailing a check to our office along with your statement or by coming by and making a payment in person.