241 W. Southlake
Southlake, Tx 76092
INSURANCE & PAYMENTS
DOCUMENTS REQUIRED TO BRING AT TIME OF SERVICE:
Completed New Patient Paper work (only for new patients).
Current insurance cards.
A current photo I.D. (driver license).
List of current medicines and their dosages.
If referral is needed, please bring referral paperwork.
We accept nearly all major insurance plans including:
To see if we accept your insurance
contact our clinic directly at 817-488-0100
Please call MediSource:
AETNA - CHOICE POS HMO OPEN ACCESS PPO
BCBS - PPO HMO TX BLUECHOICE
CIGNA - PPO HMO OPEN ACCESS PLUS
HUMANA - GREAT WEST PPO
MEDICARE AND AARP
Failure to keep your account balance current may require us to cancel or reschedule your appointment, unless other arrangements have been made.
Full payment is due at time of service.
There are additional fees for the following:
No show/No call within 24 hours of made appointment $35.00
Completion of forms (including disability) $25.00 and up.
Medical Records $25.00 and up.