New patients please arrive 15 minutes prior to your appointment to complete the necessary paperwork. For your convenience you may print out this Patient Information form and complete it in advance. Please give it to the receptionist when you check in
for your appointment.
All patients should always bring the following with them
to all their appointments:
- Insurance cards
- Photo ID
- All of your medications (prescription and/or over-the-counter)
- Co-pay, if you have one
Existing patients are reminded to keep our office updated on address, phone and insurance information so that we can communicate with you most effectively. To request the
release of patient information, please print out this form and mail, fax or bring to our office.
Prescription Drug Policy
Perscriptions and Refills: Please contact your pharmacy for any refills. Your pharmacy will contact us with any requests. Please allow at least 48 hours (2 business days) for this process.
Insurance and Co-pays
At Southside Medical Clinic we file standardized insurance claims to all carriers as a service to our patients. We are preferred providers for most insurance companies. It is the patient’s responsibility to determine if their insurance carrier will cover our services and to obtain any referrals that may be needed. The patient will be requested to pay their portion of the co-pay upon checking in for their appointment.
We accept Medicare assignment.
Billing & Payments
The patient is responsible for any remaining charges and for services not covered by their insurance plan. We will send a statement to the patient once we have received payment and/or denial from your insurance company.
If you are receiving services that are not covered by insurance, you will be required to make a payment the day of your service.
Notice of Privacy Practice
To review the privacy practices of Southside Medical Clinic and your personal health privacy rights > Download document
