No Wait or Minimal Wait Appointments. Reasonable effort shall be made to assure that Patient is seen by the Physician immediately upon arriving for a scheduled office visit or after only a minimal wait. If Physician foresees a minimal wait time, Patient shall be contacted and advised of the projected wait time.
No Wait or Minimal Wait Appointments. Reasonable effort shall be made to assure that patient is seen by the dentist immediately upon arriving for a scheduled office visit or after only a minimal wait.
No Wait or Minimal Wait Appointments. Patient shall be seen by the Physician immediately upon arriving for a scheduled office visit or after only a minimal wait. If Physician foresees more than a minimal wait time, Patient shall be contacted in advance and advised of the projected wait time. Patient shall have the option to arrive at the later projected time or reschedule the visit at a time convenient to the Patient. • Same Day/Next Day Appointments. When the Patient contacts the Practice prior to 10 AM on a regular office day (Monday through Friday) with an urgent need, the Patient shall be scheduled for a visit on that same day. Or, if this is not possible, Patient shall be given an appointment for the next regular office day.
No Wait or Minimal Wait Appointments. Every effort shall be made to assure that You are seen immediately upon arriving for a scheduled office visit or after only a minimal wait. If FCIM foresees a minimal wait time, You may be contacted and advised of the projected wait time.
No Wait or Minimal Wait Appointments. Reasonable effort shall be made to assure that Patient is seen by the Physician at the scheduled time. If Physician foresees more than a minimal delay, Patient shall be contacted and advised of Physician’s projected arrival time. Patient will then have the option to keep the appointment or reschedule the visit at Patient’s convenience. ● Same or Next Day Appointments. Reasonable effort shall be made to accommodate Patient for same or next day appointments, but cannot guarantee availability, and cannot guarantee that the patient will not need to seek treatment in an urgent care or emergency department setting.
No Wait or Minimal Wait Appointments. Every reasonable effort shall be made to assure that the Patient is seen by the physician immediately upon arriving for a scheduled office visit or after only a minimal wait. If physician foresees more than a minimal wait time, Patient shall be contacted and advised of the projected wait time. Patient shall then have the option of seeing the physician at the later time or reschedule at a time convenient to the Patient. ● Telehealth. Telehealth (virtual visits) will be available when desired and deemed appropriate by the Patient and physician.
No Wait or Minimal Wait Appointments. Reasonable effort shall be made to assure that the Patient is seen by the Physician immediately upon arriving for a scheduled office visit or after only a minimal wait. If the Physician foresees a minimal wait time, Patient shall be contacted and advised of the projected wait time. Patient will then have the option to keep the appointment or reschedule the visit at the Patient’s convenience. • Specialists Coordination. Physician shall coordinate with the Patient’s medical specialists to assure continuity of care, and if necessary, shall assist in obtaining a referral for specialty care. The fees for specialists or any other outside provider are not included in this Agreement and are the Patient’s responsibility. APPENDIX B PATIENT ENROLLMENT * Circle YES where indicated only if you agree to text message communication. Provide email address only if you agree to communication through Email. The fees as set out in the attached Appendix C shall apply to the following Patient(s), who by signing below (or a parent or legal guardian) certify that they have read and agree to the terms and conditions of this Agreement: Patient Name Date of Birth Street Address City State Zip Home Phone Cell Phone Email Do you Agree to text message communication? YES NO (Circle one) Signature: Date Patient Name Date of Birth Home Phone Cell Phone Email Do you agree to text message communication? YES NO (Circle one) Signature: Date Child/Children to Whom this Agreement Applies: Print Name Date of Birth Print Name Date of Birth Print Name Date of Birth Print Name Date of Birth Do you agree to text message communication? YES NO (Circle one) Signature parent or guardian: _ Date Relationship: Appendix C FEE ITEMIZATION Monthly Membership Fees* 0-20 years of age $ 40 per month 21+ years of age $ 80 per month 65+ years of age $ 100 per month *Maximum cost per family $250 per month One –Time Non-refundable Enrollment Fee $100 Re-enrollment fee- Should you wish to rejoin the Practice after terminating your membership or allow it to lapse, You may do so on a space-available basis subject to a $200 re-enrollment fee. Total Number of Members Total Monthly Membership Fees $ Enrollment Fees $ TOTAL DUE NOW $ (Prorated Monthly Membership and Enrollment fee)
No Wait or Minimal Wait Appointments. Effort shall be made to assure that Client is seen by the Provider immediately upon arriving for a scheduled office visit or after only a minimal wait.
No Wait or Minimal Wait Appointments. Patient shall be seen by their provider immediately upon arriving for a scheduled office visit or after only a minimal wait. If the provider foresees more than a minimal wait time, Patient shall be contacted in advance and advised of the projected wait time. Patient shall have the option to arrive at the later projected time, or reschedule the visit at a time convenient to the Patient. • Same Day/Next Day Appointments. Subject to the limitations of Paragraph 15 of this Agreement, when Patient contacts the Practice prior to 10AM on a regular office day (Monday through Friday), with an urgent need, the Patient shall be scheduled for a visit on that same day. Or if this is not possible, Patient shall be scheduled for the next regular office day. • Specialists Coordination. Your provider shall coordinate care with Patient’s medical specialists and offer guidance for referrals if requested. Patient understands that fees paid under this Agreement do not include specialist’s fees or fees of any other medical professional other than the Practice staff. Such fees are the Patient’s responsibility. APPENDIX B FEE ITEMIZATION Monthly Membership Fee • 12– 18 years of age $ 19 per month • 19-39 years of age $ 49 per month • 40-59 years of age $ 69 per month
No Wait or Minimal Wait Appointments. Every effort shall be made to assure that MEMBER is seen by the PHYSICIAN immediately upon arriving for a scheduled office visit or after only a minimal wait.
