New Patient Info

Please complete the enclosed paperwork, including the insurance section, sign where indicated, and bring the paperwork to your upcoming appointment.

Welcome to our surgical practice. We thank you for placing your trust in us to provide your healthcare and surgical needs. Please complete the enclosed paperwork, including the insurance section, sign where indicated, and bring the paperwork to your upcoming appointment. Please bring a photo ID, insurance card, and all current medications in the prescription containers, or bring an updated list of your medications. If you do not have a photo ID, please be prepared to show two forms of identification. The office has a red flag and identity theft prevention policy in place as required by the FTC.


The office will fill out short-term disability forms, Family Medical Leave Act (FMLA) forms, work forms, and other requested letters as needed. There is a $5 minimum charge for each form. FMLA forms will be priced individually based on the information requested for completion. Medical record copies must have appropriate written authorization in compliance with national HIPAA regulations and to maintain confidentiality. Fees may be charged according to standard regulation.



The office files insurance as a courtesy to our patients. Benefits are assigned to the appropriate physician. Co-payments will be collected at the time of the office visit. If you have Medicare and do not have a supplemental insurance to cover the standard 20% copay, you will be expected to pay the 20% copay at the time of service. We accept cash, checks (payable to your physician), and major credit cards. Special circumstances may arise and should be discussed with our staff prior to the appointment or surgery. If you are being seen for a colon screening and have no symptoms, you may be responsible for the initial office visit if your insurance allows only one routine screening visit yearly and your primary care provider has already billed for the routine visit. Please review your insurance policy for details. If you wish to file your own insurance, you will need to notify the business office to make necessary changes in the billing process. If you file your own insurance, we require payment when services are rendered.

We participate in the following plans: Medicare, Blue Cross & Blue Shield, Aetna, United Healthcare, NAMCI, Cigna, Principle Life, Medicaid of Alabama, and several other insurance companies. By law, Medicaid requires a referral from your primary care provider before you may see a surgical specialist. Also, some other specific insurance plans, including Tricare require a primary care referral before seeing a specialist.  If you are unsure of your insurance benefits, please call us or your insurance provider for clarification.


Payment is expected at the time of service, and copays are due the day of the visit. Your insurance benefits are a contract between you and your insurance company, and it is your responsibility to understand these benefits. If you do not have insurance coverage, please discuss financial options with the business office. Payment will be required before elective surgery is scheduled. Statements are mailed at the first of the month. Your statement will reflect the charges and payments from the previous month. As a courtesy, if your insurance is accepted, a statement will not be issued until after your insurance carrier has paid your allotted benefits. If your insurance carrier reimbursement is delinquent for 90 days, you may be asked to contact your insurance carrier directly. Please remember that any balance not covered by your insurance company is your responsibility. If this presents a financial hardship, please contact our business office to discuss the possibility of payment arrangements. If you do not cancel within 24 hours of an office visit and do not show, you will be subject to a $25 fee which will not be covered by insurance. 


Contact us today by calling (256) 216-6500 or submit your information below, and we will contact you to discuss the best surgical options for your health and wellness.


We're happy to answer any questions you may have, feel free to call us at
(804) 775-4559