Chattanooga Neurology Associates - Memorial Office -
 
Patient Forms
 
If you would like to be seen by one of our doctors, please have your physician call to make your first appointment. Remember to call your insurance company first to ensure that our doctors are within your network.
 
In an effort to help make your visit with us as convenient and productive as possible, please be sure to complete and print out our convenient on-line pre-registration forms in the privacy of your own home. Then be sure to bring your completed forms with you on the day of your visit to help make your stay with us as quick and comfortable as possible.
       



                     New Patient History Forms 
                     New Patient EMG/NCS Forms 
                     Notice of Privacy Practice
                     Imaging Service
                     Procedure Preparation
                     Work-Comp Verification Form
 
 
Financial:

Payment for services is due at the time services are rendered. We accept Cash, Credit Cards and  checks.

We will submit your insurance claim in a timely manner for payment by your insurance company. Except for adjustments, it is your responsibility to pay any deductible amount,  co-insurance, or any other balance not covered by insurance.

 Our insurance office extension is 211 and we will be happy to discuss any insurance questions that you may have.


Insurance:

We participate with many plans and will take the necessary adjustments according to our contract when claims are paid. However, your health insurance policy is a contract between you and the insurance company. It is not a contract between this office and your insurance carrier.

 Insurance companies usually issue a disclaimer stating that payment is not guaranteed until the claim is received and reviewed. Some companies will pay fixed allowances while others pay a percentage of the charge and some procedures may not be covered at all.

Remember to call your insurance company prior to your appointment to verify coverage.


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