New Patient Registration — All You Need Is Right Here!
As is true for all medical practices, our new patients must register and authorize us to treat them before we can see them. Unlike most practices, we have made the process as simple and easy as possible. All you have to do is complete 2 forms — our Registration and Authorization Forms — which you can access below and submit directly from this website. Medicare patients must submit one additional form, called an ABN (Advanced Beneficiary Notice), which you can also access below and submit directly from here.
Please scroll down the page to find our Registration and Authorization Forms. If you are insured by Medicare or a Medicare Advantage Plan, you will also find the ABN. If you have questions about any aspect of this process, please don’t hesitate to call our office. Our support personnel are knowledgeable, understanding, and eager to help.
Registration Form
The registration form provides us with the information we need to identify and communicate with you, and bill your insurance company. Our registration process is simple compared to most practices, and there are several ways you can do it.
Call our Office: You can register by calling our office and speaking with our registration team. To expedite the process, please have your insurance information handy when you call.
Register Online: You can also register on line by clicking the “On-line Registration” link and filling out the on-line form which, when complete, can be sent securely and directly to our office.
Fax or Mail: You can click the “Download Registration Form” link, complete the form, and mail or fax it to our office. (See below for contact information)
Authorization Form
Just one more form to complete – the authorization form – and you’re done with the process! Click here to complete the form online.
This form accomplishes several things: It allows DMHC to acquire medical records, and to provide insurers with information about, and receive payment for, services rendered; it documents our communication about DMHC’s privacy practices; and it establishes who is responsible for payment.
The authorization form must be signed by the patient or the patient’s responsible party (parent, guardian, power or attorney). Therefore, please print the form, complete and sign it, then mail or fax it to our office.
ABN Form (Advance Beneficiary Notice)
The ABN is a type of informed consent. It authorizes a physician to provide services which the physician or patient deems medically necessary, but which Medicare does not pay for as a benefit. Patients only pay for those services when they explicitly authorize a physician to provide them, at the price stated on the ABN form, and they actually receive those service.
Access the ABN form by clicking this link “ABN Form” then completing the form on-line and clicking “submit” at the bottom of the form to send it securely and directly to our office.
Orientation Guide - For Families Of Residents In Senior Communities
This is a useful “how to” guide on making highest and best use of our service in independent and assisted living communities. Click this link to go directly to the guide, which can be viewed online or printed for future reference.
Contact Information
Our fax number is 919-933-6881.
Our mailing address is 4220 Apex Highway, Suite 200, Durham, NC 27713.
