Informed Financial Consent Policy
Effective November 1, 2011
In order to provide all our patients with the best care possible, we ask that you make every effort to keep your scheduled appointments and arrive at least 15 minutes early for your appointment, to update your personal and health history information. We respect your time and try to see our patients on time. By arriving on time you allow us to see you for the entire duration of your allotted time and ensure that the patients scheduled after you are likewise given the same opportunity. Therefore, if you arrive late by 15 minutes or more you MAY be asked to reschedule your appointment or wait until we have a time spot for you.
The office has a new computer system, which includes electronic medical records. In an attempt to make this transition as easy as possible for our patients, we ask that all patients present both their insurance cards and driver's license at each visit.
If you need to reschedule or cancel an appointment, we require a MINIMUM of 24 Hours cancellation notice. Adequate notice allows us to offer the appointment to another patient who needs to see the physician. Please remember that confirmation reminders from us are only a courtesy, our failure to confirm your visit does not relieve you of your responsibility to cancel your appointment.
$50 Fee will be charged when a patient fails to provide us with at least 24 hour notice of cancellation, or is a "No Show" for a scheduled full exam appointment and $25 Fee for a scheduled follow up or emergency appointment.
ALL Fees, which are your responsibility, are due at the time of your appointment. These include any co-payments, refractions, co-insurance, deductible, or any other charges not covered by your insurance.
Failure to pay at the time of your appointment will result in an additional $10 administrative service fee to be added to your bill.
Please note that these charges are NOT billable to your insurance and are your responsibility. All fees must be paid before your next appointment with one of our providers.
Ronald D. Klug, M.D.
Jason I. Steinfeld, M.D.
Denise Balacich, O.D.
To Cancel or Reschedule, please call our office at:
24 hours prior to your scheduled appointment time.
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