| |
| |
 Patient Forms
|
| |
|
To schedule an appointment with , Dr. Mark Herron, please call: (334) 277-3332
We now accept new patients by physician referral . Our regular office hours are Monday through Thursday 8:00 a.m. to 5:00 p.m. We are closed on Fridays.
The form to your right can be downloaded and printed at home. By filling out this form ahead of time, you will save a significant amount of time during your visit. Please be prepared to provide this information to our office along with your current insurance information. You will need Adobe Acrobat Reader in order to view the form.
If you are unable to keep an appointment, we ask that you kindly provide us with at least 24 hours notice. This courtesy, on your part, will make it possible to give your appointment to another patient.
If you have insurance through a company that we have contracted with, we will bill your insurance company for the visit. We will require a copy of your insurance card and a driver's license. All co-payments, co-insurances and deductibles are due at the time of visit, no exceptions. You will be responsible for any services denied by your insurance carrier as not medically necessary and/or not covered.
|
- Blue Cross/Blue Shield of Alabama
- Medicare
- Medicare Complete
- Viva
- United Health Care
- PCHS
- Health Choice
|
- Beech Street
- Seniors First * must have written referral *
- Tricare * Tricare Prime must have paper referral *
- Medicaid * Must have written referral *
- First Health
- Cigna
- Health Spring of Alabama * Must have written referral *
|
|
|
