Patient Forms

Patient 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.

 

Payment & Insurance

We accept the following forms of payment: Cash, Check, Mastercard, Visa, 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. 

 

 

 

We are in-network with:

IF YOU DO NOT SEE YOUR INSURANCE BELOW, PLEASE CALL OUR OFFICE

 

 

 

Please bring the following items with you to every appointment:

  • Photo ID such as driver’s license or state-issued ID
  • Insurance card(s) and information
  • Payment via MasterCard, Visa, American Express, or personal check
  • Please have available a complete list of medications you are currently taking, including any over-the-counter medications, vitamins or supplements.
  • Complete list of other physicians you see, their contact information, and why you see themResults from any tests conducted by other health care workers outside of Remix Medical since the last visit, including any progress notes.