Thank you for continuing to choose Miki and Alfonso Hand and Upper Extremity Center. We look forward to your visit.
If you would like to complete the follow-up patient paperwork prior to your visit, please print the required forms and bring them completed to your appointment. If you would prefer to complete the follow-up patient paperwork at the time of your appointment, our front desk staff can provide these forms to you at the time of your check-in.
Step 1: Please complete the form that applies to your situation. Please note that the entire form does not need to be completed again unless there has been a change in your insurance information. If there hasn't been a change in your insurance information please complete only the top few lines, check off that you are a follow-up patient, and sign.
Situation 1: I will be using my health insurance.
Situation 2: I was involved in an accident and will be using a Personal Injury Protection (PIP) Policy and my health insurance as secondary. (Note: Three more forms required on check-in.)
Situation 3: I will be using my employers' Workers Compensation Policy. (Note: Your case manager and/or adjuster must be aware of your appointment.)
Situation 4: I have an attorney and will be being seen under a Letter of Protection which my attorney has arranged.
Situation 5: I will be paying for myself.
Step 2: Bring your completed paperwork to your appointment.