Forms & Policies
Women's Contemporary Health-Care strives to provide every patient and their families with high quality services. For your convenience, we have provided some commonly used documents below.
Patient Forms
Before your appointment with us, quickly and conveniently access patient forms from our practice.
Download Patient Forms
To view the forms listed below, you will need Adobe Reader. You may download Adobe Reader for free at www.adobe.com. Please bring your completed forms with you to our office at the time of your visit.
Office Policies
Scheduling Information
- Patients are seen by appointment only. Appointments can be made by calling our office during normal business hours. Arriving on time makes it possible for you to be seen as scheduled. If you need to fill out paperwork please arrive 15 minutes prior to your appointment. If you arrive more than 15 minutes late your appointment may need to be rescheduled.
- You should have received your login credentials for your electronic medical record. Your appointment and time with the provider will be GREATLY enhanced if you will take a few minutes prior to your appointment to log on and update your file. If you have not received the login credentials, please contact us as soon as possible and we will provide this to you.
- You are responsible for your scheduled time, but as a courtesy to you, we will attempt to confirm appointments at least one day in advance of your appointment.
- We require a 24 hour notice to reschedule or cancel your appointment. We understand that there are situations that are unavoidable but if you do not notify the office, at all, you are considered a no show to your appointment and will be charged $25.00.
Insurance and Payment Information
- You are responsible for checking with your insurance company to verify that our providers are on your plan.
- Please bring your insurance card and co-payment with you to every visit. If you do not have either your appointment will be rescheduled or you can choose to pay for the visit in full and you would be reimbursed after your insurance pays the claim.
- Self Pay: Any patient that does not have insurance coverage is considered self pay. We require payment in full for each visit.
- Existing Patients: You are responsible for any amount that insurance does not pay. You are required to pay on any unpaid balances. If your account is in collections, we require the balance to be paid in full at your next appointment before you are seen.
- We accept VISA, MasterCard, Discover, American Express, check or cash as payment for any uncovered portion of your visit. There is a $25.00 fee for returned checks.
- There is a $15.00 fee for any forms that need to be completed for disability, FMLA, or any other forms. This will be collected when you drop off the form or when you pick it up. The form will not be released until this fee is paid in full.
After Hours & Emergency Care
If you are experiencing an emergency, dial 911 or head to the nearest emergency room. For all other calls, an on-call provider is available 24-hours a day, 7-days a week. You can reach the on-call provider at our regular office number (614-891-6211) and pressing 8 to reach the answering service.
Prescription Renewals
Prescriptions are renewed during normal office hours and cannot be done online or through email. In some instances, we may require that the patient be seen in our office prior to medication renewal. We are utilizing e-prescribing, so please provide specific information on your desired pharmacy in any message.
