Patient resources

Insurance and billing information

For the benefit of our patients, we are contracted with several insurance carriers. We accept medicare, most major commercial insurance plans and Medicare replacement plans. Scholarships may be available to those who qualify based on financial need.

Patient forms

Consent for treatment

Patient information

Request for medical records

Future research contact form

Consent to be observed

Telehealth consent (if applicable)

Privacy practices

The clinic and clinic personnel comply with the privacy regulations required by the Health Insurance Portability and Accountability Act. Every effort is made to ensure the confidentiality of information shared in the process of managing your case. Access to clinic charts is limited to clinical faculty and only those students directly involved in your immediate care. All patients complete a privacy notice annually providing explicit instructions regarding the use and disclosure of their protected health information including with whom relevant information can be shared such as the patient’s physician, school or other professionals. Please refer to our notice of privacy practices for more information about your rights to privacy.

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Patient resources

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