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Office Information: About Your Visit

Identity Theft and Insurance

Our office is required by Federal and State laws to comply with the Federal Trade Commission's Red Flag Rule in the prevention of identity theft and insurance fraud.

We will require a valid form of identification along with your actual insurance card at the time of check in. Samples of acceptable identification can be a driver's license, credit card, membership card or phone bill with your name and address listed.

Thank you for helping us aid in the prevention of identity theft and insurance fraud.

Please complete and download the highlighted forms and bring the following with you to your appointment to avoid delays:

• Your driver's license
• The completed Patient Registration insurance information sheet
• The Patient Health History sheet
• The Worker's Compensation Information form (if applicable)
• Please download and review our Notice of Privacy Practices and sign the Acknowledgement of Receipt
• Please read our Financial Policy Statement

Arrive 15 minutes early to your appointment to allow us time to enter and update your medical record.

Be prepared to pay your co-pay which is required at the time of your visit. This amount is designated by your insurance company.

Bring any diagnostic tests pertaining to this injury/visit such as x-rays, MRI's, CT scans which were performed previously. If you do not have them in your possession, please contact the office or facility where they are being held and arrange to obtain them for your visit.

If you are filing for Worker's Compensation, please download the above WC form and provide the following required information:

• Claim number of your case (assigned after filing 1st Injury report with your employer)
• Name and address of your employer's Worker's Compensation Insurance Carrier

You can get more information regarding worker's compensation by visiting the following link: http://www.wcc.state.ct.us/

If this visit is related to a Motor Vehicle Accident, please bring the following with you to your appointment:

• Name, address and policy number of your Auto Insurance Carrier
• Declaration page from policy reflecting medical coverage limits (if applicable)
• If you did not purchase medical coverage on your auto policy, you will need to bring a letter from your Auto Insurance Agent confirming that there is not coverage in order for us to bill your health insurance carrier

This information may be faxed to us ahead of your appointment time to avoid delays in scheduling at 860.644.5978.

Methods of Payments

We accept cash, check, Mastercard, Visa, Amex and Discover. Payment is expected at the time services are rendered. If you have any questions, please review our financial policy. We offer online pay for your convenience.

We do not bill third party insurance carriers. If you have any questions, please call our office at 860.644.5900 and we will be happy to assist you. .

We look forward to being "Your Partners in the SPORT of Life".