Thank you...
...for considering membership in Empower Family Medicine!
OUR PROMISE to you as a practice member
includes a commitment to:
* Be present, punctual and attentive, courteous and respectful.
* Provide high quality evidence-based information for you to make the best possible health decisions
* Provide up-to-date medical knowledge and experience for your care.
* If a question or concern arises we cannot answer, we will research the issue
or refer you to an appropriate specialist to address your concern.
OUR PROMISE to you as a practice member
includes a commitment to:
* Be present, punctual and attentive, courteous and respectful.
* Provide high quality evidence-based information for you to make the best possible health decisions
* Provide up-to-date medical knowledge and experience for your care.
* If a question or concern arises we cannot answer, we will research the issue
or refer you to an appropriate specialist to address your concern.
How to Join
New Patient Checklist ____ Use our contact page to ask questions or call to schedule an information session with Dr. Black. ____ Review "Frequently Asked Questions" to learn about our office policies & service fees. If you have private health insurance, you may wish to contact your insurer to confirm that they will cover any lab, radiology or specialist referrals recommended by a direct primary care provider, as coverage may be restricted in some insurance plans. If you have a health spending account (HSA) call your plan manager to ask if your monthly fee is reimbursable. ____ Review the Enrollment Forms which include a.) EFM Patient Agreement b.) Authorization to Release Healthcare Information c.) Medicare Opt Out Agreement (if you are Medicare eligible) and d.) Privacy Policies. You will be given the opportunity to ask questions about our office policies and patient agreement at your initial visit. The enrollment forms will be completed at your initial visit. ____ Complete a Medical History form. Please be sure to include a detailed list of past healthcare providers *** including their phone and fax number. *** We find that people get the most benefit from their initial visit if some medical history is available beforehand. If desired, you can complete the medical history and email, mail, deliver, or fax it to out office prior to your appointment. ____ Obtain a copy of your medical records prior to scheduling your first visit. Medical records may be faxed to 1-888-213-8479. Receipt of medical records can take 30 days or more. You will receive notification by phone or email when your records are received. ____ Call the office to schedule an initial visit. The initial visit fee is $150 pad at the time of scheduling. Visit fees are non-refundable, but appointments may be re-scheduled as necessary. ____ When you come to your initial visit, please bring your medical records and pill bottles for review. ____ If, after your initial visit, you would like to enroll as a member for continued primary care, you can do so via the "Enrollment" menu above with the link "Enroll as a New Patient." This will take you to PayPal where you can set up monthly credit or debit draft for the monthly service fee. This may be cancelled at any time. Once cancelled, individuals are not eligible to re-enroll until 12 months from the date of cancellation. We do not accept payment by cash or check. *Please note : Empower Family Medicine relies heavily on the use of computer technology to facilitate detailed medical record keeping and allow you to have rapid access to your physician. All practice members are required to have internet access and be able to use the online patient portal, or to have a designated healthcare advocate (trusted family member or friend) who does. The office is also paperless, so most medical forms and records will be completed digitally and provided to you by patient portal or encrypted email for printing at home when needed. |
Medicare beneficiaries are welcome! If you are enrolled in Medicare, you will be responsible for the $150 enrollment and $75 per month membership fees. Other expenses such as labs, imaging, hospital or home health are billed to Medicare as usual.
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