Patient Forms & Resources

PATIENT FORMS
Accepted Insurance
Billing Policies
ONLINE BILL PAYMENT
OFFICE HOURS
Financing Options

We are excited to provide excellent medical care for you. We partner with Simple Interact (see below for FAQs), a completely secure and comprehensive forms service. Here is what to expect before your visit:

  • Before your first visit, you will receive a New Patient Forms Request after booking your New Patient appt. Please complete these forms as soon as possible.* We can start prepping your chart ahead of time to make your visit as smooth as possible.
  • If you are a returning patient, you will receive a Digital Check In Request the day before your appt. Please complete this as soon as possible.* We can start prepping your chart ahead of time to make your visit as smooth as possible.

What items will you need to bring with you?

  1. Driver’s License or Photo ID
  2. Insurance Card

We look forward to seeing you!

  • If you have not received the forms, make sure that you have an appointment booked. Please call one of our clinic locations today.
  • If you do have an appointment booked, but have not received the forms request, please call one of our clinic locations today. Please help us make your experience as efficient as possible!

FAQs about SIMPLE INTERACT:

Simple Interact is a mobile-friendly front office automation platform that provides patients with easy access to forms, delivered directly to your device. You can complete your forms anytime and anywhere at your convenience.
Why am I getting an email/text to complete forms?

Through Simple Interact, we have automated what information we need from you and when, so that you never have to complete unnecessary forms. We only ask for what we need when we need it.

I do not like giving my personal info digitally. How can I be sure that it is secure?

Simple Interact is 100% compliant with HIPAA law and regulations. You can be sure that every page, every answer is seen only by your provider and the necessary medical support staff.

I am not a new patient, so why am I getting a request to complete forms?

The request you received from Simple Interact is a Digital Check In, which retrieves your previously recorded info for review. By completing this ahead of your appt, you are greatly reducing your check in process for your appt tomorrow. Give your future self a break!

Do I have to download an app or manage yet another portal username and
password?

For the Simple Interact forms, the link is securely delivered to your device. You only need to go through a simple authentication process and you will have access to your forms.

English is not my preferred language. Do you have translations of the forms?

Excepting the legal forms, all forms have a language setting in the upper left corner to make the language more convenient for you.

Accepted Insurance

This list contains most of the insurance plans that we currently accept. Even if your insurance is not listed here, we may still be on your plan. Please call the office and we will check for you. If we are not a part of your insurance plan, we can still provide your care, but out-of-network benefits will apply. We will be happy to contact your provider to determine your out-of-network benefits.

  • ACCOUNTABLE PPO
  • AETNA HMO/POS/PPO
  • AFFILIATED HEALTHCARE PPO
  • BCBS HMO
  • BCBS PPO/POS/EPO
  • BEECH STREET PPO
  • CCNCHOICE
  • CARECIGNA PPO/HMO
  • FIRST HEALTH
  • GALLAGHER (UNDER PHCS)
  • GOLDEN RULEGREAT WEST HMO/PPO
  • HEALTHSMART PPO/POS/EPO
  • HUMANA ( UNDER CHOICE CARE)
  • MEDICARE
  • MULTIPLAN PPO
  • MUNICIPAL HEALTH PLANS
  • NTHN PPO/POS/EPO
  • ONE HEALTH PLAN HMO/PPO (UNDER GREAT WEST)
  • PACIFICARE PPO
  • PACIFICARE HMO
  • PHCS PPOPHCS
  • OPEN ACCESSPLAN
  • VISTA SOLUTIONSPPO
  • NEXT (HLTHSTAR, MED CONTROL, PREF HLTH)
  • PRO AMERICA PPO
  • PRO NET PPO
  • TEXAS TRUE CHOICE PPO
  • UNICARE PPO
  • UHC PPO/HMO/POS/EPO
  • UNITED AMERICAN INS CO

Billing Policies

  • Office charges are due and payable at the time of service.
  • Our Billing Office can help facilitate insurance claims and questions you may have. Accounts 60 days old are considered delinquent and those at 90 days will be reviewed for action.
  • Professional services are rendered to the patient, not an insurance company. Since every insurance plan is different, please be sure to check your coverage and ask questions before services are rendered. We are here to help in any way we can.
  • The doctor may perform certain procedures or services that are necessary as part of your evaluation and treatment, for example, a scopeof your nose or throat. Because this procedure, according to the American Medical Association, is considered an office surgery, your insurance company may or may not apply these procedures to your deductible. You will be responsible for your co-insurance at the time that services are rendered and also any portion of your bill that your insurance plan does not cover.
  • If you have questions about your specific insurance plan and your financial responsibility please ask one of the receptionists prior to seeing the doctor. Your insurance can deny payment for services or procedures after they are performed. We advise that you know the benefits of your individual plan.
  • Payment may be made by cash, check, Visa or MasterCard.The office participates in a variety of health insurance programs.
  • If you are a participant in a Managed Care program, you are expected to pay your co-payment at each visit. Failure to do so can result in action by your insurance carrier. Managed Care patients are liable for co-payments, per their carrier, for appointments not canceled in advance.
  • The Billing Office files claims for all carriers that we accept. Payments by the insurance carriers will be made directly to our office. They will provide you with an Explanation of Benefits (EOB) of the charges, amount covered by your policy, and payments made to our office on your behalf.
  • Your insurance may or may not allow a portion of your bill, the remaining balance is your responsibility. If you have a secondary plan, as a courtesy, the billing office will submit the primary payment information to the secondary carrier.
  • The Billing Office submits all Medicare claims for you. We also provide Medicare with your secondary insurance information. Through their crossover program, your secondary insurance will be billed directly by Medicare. Please check to see if your secondary insurance requires a signed waiver in order for this to happen. Our office will bill insurances not included in the crossover program.
  • You are responsible for yearly deductibles, non-covered services, and co-payments when there is no secondary insurance. As a courtesy, the Billing Office files claims to carriers that we do not accept. Payments by the insurance carriers may be sent directly to the patient instead of our office. It is the responsibility of the patient to remit payment to our office in these cases. If you have a secondary plan, as a courtesy, the billing office will submit the primary payment information to the secondary carrier.
  • Special consideration will be given to patients financially unable to pay in full at the time of service. Arrangements should be made in advance with the Billing Office.

Online Bill Payment

Patient Account #:

Office Hours

Appointments. Patients are seen by appointment only, however, if there is an emergency, every effort will be made to provide care. Please call the office to schedule your appointment. Should you need to reschedule or cancel, please notify the office as quickly as possible.

Telephone Consultations. Patients are encouraged to call the office with questions they may have regarding medical problems. The office staff is trained to handle many of the questions you may have. If they are unable to answer a particular question, the Doctor will return your call.

Emergency Care. If you have a true emergency, please call 911. For other concerns, please do not hesitate to contact the office and explain the urgency of your call. After regular office hours, call the office number for instructions on how to reach one of our physicians on-call.

Office Hours

WeekdaysPhysicians*Audiologists
Monday9 am - 4:30 pm9 am - 4:30 pm
Tuesday9 am - 4:30 pm9 am - 4:30 pm
Wednesday9 am - 4:30 pm9 am - 4:30 pm
Thursday9 am - 4:30 pm9 am - 4:30 pm
Friday9 am - 4:00 pm9 am - 4:00 pm

*Not all physicians may be available at all times. Surgical hours are not reflected.

Billing Department hours are Monday – Thursday, 8:30 am – 5:00 pm; Friday, 8:30 am – 4:00 pm. Appointments are recommended. Please call  (214) 382-5100.
11970 N. Central Expressway
Suite 400
Dallas, TX 75243
214-382-5100
Legacy Medical Village
5425 W. Spring Creek Parkway
Suite 145
Plano, TX 75024
214-382-5100

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