Dear Patient

Thank you for scheduling an appointment with Dr Shantz or Dr Freas. It is our pleasure to welcome you to our practice in advance of your first visit.

You will find some information here that will help familiarize you with our practice. If you have any questions after reading the material, please give the office a call. Enclosed is a patient registration form and past health history questionnaire. Please complete these forms and bring them with you to your appointment.

Please bring with you the following items for each of your visits:

• Insurance ID card
• Picture ID
• Office visit co-pay (we accept cash, checks, and MasterCard or Visa payments). Your co-payment, if required by your health insurance company, is due at time of service.
• Copies of old medical records. If not available we have a form here in the office that you may use to request that records be sent to our office from your previous physician.

Please arrive 10-15 minutes early to allow time for registration and time to contact your insurance carrier to verify/designate Waugh Chapel Family Medicine as your primary care office.

Kindly give 24 hours notice if you are not able to keep your appointment. This will enable you to avoid our $25 “no-show” fee.

We require 3 days advance notice to prepare your routine referral requests (although often we have them done in a matter of minutes).

For prescription refill requests, please allow 24 hours for us to check the records and contact your pharmacy. We usually have these done by the end of the business day (after seeing patients).

We appreciate your selection of our office to provide your medical care and we will work hard to serve your needs.

Sincerely,

The Physicians and Staff of Waugh Chapel Family Medicine