Patient Intake Forms
If you are new to Remix Medical and have scheduled an appointment, please complete the appropriate New Patient Intake form below. Be advised, you may be asked to take picture or scan your insurance information and identification cards.
- Patient Access of Medical Records
- Telemedicine Consent Form
- HIPAA Notice of Privacy Practices
- Authorization for Medical Record Release
Payment & Insurance
We accept the following forms of payment: Cash, Check, Mastercard, Visa, Discover, American Express.
We are in-network with multiple insurance providers. For a more complete understanding of your financial responsibility, contact your insurance provider. You may also contact our office to learn more about financial assistance options.
We routinely file claims and accept insurance payments as a courtesy to our patients. Please note that some plans have yearly maximums, deductibles, waiting periods, limitations, alternate benefits, and missing tooth clauses that may limit your benefits.
