prefer to print?
Note: If you are printing the documents, please submit the completed forms via email, fax, or mail prior to your appointment
•Please bring your insurance card(s) and a photo ID to your appointments.
•Please complete all necessary paperwork before your scheduled appointment.
You may submit them electronically through our website (if applicable) or bring them with you to your appointment.
Do not mail or fax your patient forms.
•There will be $50 fee for new patient appointments that are not cancelled within 24 hours.
•There will be $25 fee for established patient appointments that are not cancelled within 24 hours.
•If you have a balance on your account, a payment must be paid on your next visit, or it can be paid in full.
•We kindly ask that you abstain from wearing strong perfume to the office as a courtesy to others.
•Be advised that you are responsible for reporting any changes to your address or insurance.
•There will be a $25 charge for any documentation that needs to be filled out by Dr. Neiman.
•Please do not use the office answering service for refill requests. Please call your pharmacy to request refills.
•If you insurance requires a referral from your PCP: Please do not make your appointment until you have a referral.
We will not see you until we receive the referral in our office.
•A copy of these policies will be kept in your chart for our records to confirm that you have been notified of these policies and agree to abide by them.
Thank you in advance.
Acknowledgement of Office Policies
I have carefully reviewed Dr. Neiman’s office policies and I agree to abide by them.