Office Policies

Information Changes

  • Please inform the office immediately of any changes to your name, address, telephone number, or insurance.

  • You are responsible for any costs / denied claims due to incorrect insurace information.

Payments

  • We accept Visa, Mastercard, American Express, checks and cash.

  • Co-payments and/or balances are to be paid at the time of your visit.

  • Patients who are without health insurance are required to pay $200 for the initial visit and $150 for follow up visits.

  • There is a $15.00 fee for any returned checks.

 

Medical Records

  • A signed release is required for medical records to be released from this office.

  • There will be a $35.00 fee for a printed medical record.  Paper records will not be released until payment is received.

  • Records will be sent within 3 business days of payment.

  • Electronic copy of medical records may be requested to be sent to another physician at no charge.

 

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© 2014 by Sepulveda & Associates.