Any data about your health is extremely sensitive. Therefore you should be able to decide for yourself who can access your personal health record. This is given highest priority at [YOUR PRACTICE NAME], and under no circumstances do we allow access to your data by anyone other than you.

Your trust and confidence is our biggest concern. Our online patient communications are encrypted across all platforms.

Our security certificates (e.g. SSL encryption) are provided by COMODO SSL. COMODO currently provides the highest possible encryption methods for e-commerce transactions and the transfer of sensitive data over the Internet. Trusted by clients such as IBM, Microsoft, Intel, BP, Shell Oil, Expedia.com, Novell, Oracle and others.

Therefore, your data is always in safe hands at [YOUR PRACTICE NAME]. As soon as you log in to your personal health record, you switch over to our secure server. Your password, medical documentation and financial details are always encrypted and handled securely. By using the latest technology, your personal health record is always protected against access by unauthorized users.

When you access our website, you enter a secure area. SSL encryption ensures that your data is transferred from your computer to our server without being read, changed, or deleted by third parties. This is shown by the padlock symbol bottom right in the status bar of your Internet browser. Any payment information we receive from you is not retained in any manner by our system. All payment transactions (for ePatientPayment services only) are handled completed by PayPal, with 100% protection for unauthorized payments sent from your account.

When you register as a patient, you select a personal user name and password. Thereafter, you will use this data to log in to your account. Please ensure your user name is between 8 and 20 characters in length, consisting of a combination of numbers, lowercase and uppercase letters (except for umlauts such as ä,ö,ü and ß), and special characters. Permissible special characters are *[](){}!@#$%_. This decreases the likelihood of others recognizing and remembering your password. As an additional precaution, you should alter your password regularly under "My Profile".

Server certificates check the identities of the computers that communicate with one another and only allow authorized servers to exchange information. Additionally, special SSL encryption prevents unauthorized parties from accessing sent data and thus protects your privacy.

Our office is open from 8:00 am to 5:00 pm, Monday through Friday. Some of the services we offer include: [LIST PRACTICE SERVICES].

If you require special assistance (wheelchair, transfer to exam table, language, etc.) please let our office staff know prior to your arrival for the appointment so that we may make arrangements to obtain assistance, if possible.

Everyone here at [PRACTICE NAME] understands that your time is just as valuable as ours. We make every effort to keep your wait to see our health care providers to an absolute minimum and make rescheduling your appointment unnecessary. However, from time to time, it may become necessary for us to reschedule your appointment date and/or time, or the wait may be extended, as our physicians may be on-call for emergencies with local hospitals. In these rare instances, we kindly ask for your understanding and cooperation. These situations are unexpected and unpredictable, but if one does occur, please be assured that we will make every effort to minimize your inconvenience.

If you are unable to keep your scheduled appointment, please give our staff at least 24 hours notice. Due to limited availability of appointments, you could be billed $100 as a “no-show” fee if you miss your appointment without the required 24 hour notice.

Full payment is required at the time of service, as well as for patients whom we are not providers with their insurance carrier. For your convenience, we accept cash, MasterCard, Visa and Discover credit cards.

As a courtesy to our patients, we file all insurance claims, even if we are not providers for the insurance. It is your responsibility to furnish our office with a current copy of your insurance card(s). For patients whose insurance has a copay, the copay must be paid on the day of service. For patients who have Medicare, but no supplement, 20% of the office charges will be due at the time of service. For patients with no insurance or insurance for which we are not a provider, payment in full is due at the time of service unless prior arrangement have been made with our office management staff.

We are participating providers for: BlueCross/BlueShield, Champus, Encompass, Ethix/MidRivers/ProAmerica, Great Rivers, Great West, Group Health Plan, Healthlink, MedAmerica Healthnet Blue, Medicaid, and Medicare.

Regarding accidents, legal cases, etc. where you, the patient, believes someone else is responsible for medical expenses requires that you as the patient must be responsible for payment to [PRACTICE NAME] at the time of service. Our office cannot be expected to wait for court decisions, conclusions, or disputed insurance settlements. We will assist with any paperwork, etc. required for reimbursement from the third party believed to be liable for your medical expenses.

Please Note: Any accidents, such as cuts, burns, falls, etc., filed with health insurance may result in a follow-up form from your insurance. This MUST be filled out and returned immediately. All outstanding balances will become your responsibility until these forms are completed and returned. We DO NOT file Auto or Third Party liability insurance, but we will provide you with a claim form to send to your insurance carrier. If you are unsure if this policy applies to you, please consult with our office staff.

In cases of Workers’ Compensation cases, we must have an authorization form from your employer or the employer’s insurance carrier to provide medical services. If your claim is denied, you are responsible for payment of the services provided.