Patient Forms & Info
New Patient Paperwork
All new patients need to complete new patient paperwork. For your convenience, the forms are available for download. Print, complete and bring the forms to your appointment.
Patient Registration | PDF Download
Financial Policy | PDF Download
HIPPA Acknowledge Receipt | PDF Download
Preparing For The Closure Procedure | PDF Download
Home Care After Closure Procedure | PDF Download
Preparing For Microphlebectomy | PDF Download
Home Care After Sclerotherapy | PDF Download
Home Care After Excisions | PDF Download
** Please bring your insurance card and co-payment (if applicable) to your appointment. If your insurance requires a referral, please be sure to contact your PCP prior to your appointment or we may have the reschedule you. If you are unable to do so, please call ahead to make appropriate arrangements.
Contact the Business Office For:
- An explanation of your bill
- Payment arrangements
- Other billing or insurance related questions and information
610-200-6924, ext. 1
Insurance plans we accept:
Aetna US Healthcare HMO / Aetna Managed Choice / AmeriChoice HMO / AmeriHealth HMO-IBC / Blue Shield – Blue Choice / Independence Blue Cross / Keystone Health Plan East / Personal Choice-IBC, Horizon of NJ’s Managed Care, PPO/traditional, Horizon Medicare Blue, MEDICARE Part B, OneNet PPO, First Health Network PPO, Clear care PPO, Devon PPO, Evolutions Healthcare PPO, Coventry Health Care National Network, Galaxy health Network PPO, Great West Healthcare, Health America of PA/Coventry of DE, Fortified Provider Network, InterGroup PPO, JeffPLUS, Medical Resource, Inc./NPPN, Multiplan, PPO Next, Preferred Care PPO, PHCS. Although not participating with, we do frequently accept Cigna and United Healthcare patients who have out of network benefits. If you do not see your carrier here, please ask us.
If you are covered by any of these carriers, it is necessary for you to provide our staff with the required information that enables us to bill your carrier. Almost all participating insurance plans may leave a balance that you must pay in the form of a co pay, deductible, and/or co-insurance. It is not our responsibility to know what limitations, exclusions, deductibles or co-pays each group might leave to a patient’s responsibility. It is the patients’ responsibility to know your benefits, but we are glad to help you navigate the maze that has become health care benefits.
Due to the changing nature of health care and reimbursements, acceptance of insurance carriers is subject to change at any time
Please call us if you have any questions or need assistance. Our office can be reached at 610-200-6924 during the following hours:
Monday 8:30 AM to 12:00 PM and 1:00 PM to 4:30 PM
Tuesday 8:30 AM to 12:00 PM and 1:00 PM to 4:30 PM
Wednesday 8:30 AM to 12:00 PM and 1:00 PM to 4:30 PM
Thursday 8:30 AM to 12:00 PM and 1:00 PM to 4:30 PM
Friday 8:30 AM to 12:00 PM and 1:00 PM to 4:00 PM
We may ask that you reschedule your appointment if you are 20 minutes or more late.
We do our best to see our patients on time and give each patient the individual attention they deserve.