New Patient Paperwork

There is no need to stop by our office to pick up our most commonly used patient forms ⁠— download what you need here. The following forms have been made available for our patients. Prior to your first visit with us, download and print the appropriate form. Please complete the form and bring it with you to your initial appointment.

• Patient Intake Form  
  
• New Patient Questionnaire
• Motor Vehicle Accident Questionnaire

Davis Spine & Orthopaedics' Policies

& Patient Information

Fees

We strive to assure you receive the best orthopedic care available, and we also work to keep our fees as low as possible. Our fees are comparable to other orthopedic groups in the Tampa area. We are always willing to discuss our charges with our patients. Should you need additional time to pay for our service, you must set up a payment arrangement with us to avoid late fees.

It is customary to pay for medical care the day it is received. If you are covered by an HMO, PPO or Medicare plan, you should expect to pay any co-pays or deductibles at the time of each visit to our office. For your convenience we accept Visa, MasterCard, American Express, cash, or personal check. Note: There is a $40 charge for any returned check.

We will be glad to work out an individual payment plan with you if necessary, and if you request it in advance. In return, we expect you to make regular, on-time monthly payments. We reserve the right to charge interest on any account that is sixty days past due. For all billing questions, please contact our billing company, Physicians Medical Billing at 410-335-0008 ext: 145 (Lisa).

Financing

We mail statements monthly. Payments are due in our office fifteen days after you receive your statement. If you have a hardship and need more time to pay, please speak with a financial secretary right away. We can always work out something if you talk with us, but failure to call us could leave us no choice but to ask for full payment of your account.

Payment plans are available to those patients that may qualify. A $25 late fee will be applied on missed payments.