Forms:
New patients are required to fill out the following forms prior to being seen by our surgeons at Coastal. We provide these forms in a PDF format - if you do not have Acrobar Reader you will not be able to view them. If you want a free copy of Acrobat Reader (download here), click on the link and you can download the program. Please click on the form to open, then print and fill these out. Be sure to bring the forms with you on your first visit. On your first visit we will need a copy of your current insurance card and a photo I.D.
Patient Information Sheet
Patient History Sheet
Release of Medical Information Sheet
Fees and Insurance
Our office participates with the following insurance companies, if you don’t see yours give our billing department a call to check: Medicare, Medicaid, Aetna, CIGNA, CCN, TRIGON HealthKeepers, MAMSI, Multiplan, Optimum Choice, Optima, Private Healthcare Systems, Sentara Health Systems, TRICARE, Unicare, Vicare, and Virginia Health Network. We will bill your insurance company along the guidelines of our contract.
Remember that your insurance coverage is a contract between you and your carrier, and as such is your responsibility. As a reminder, co-payments, non-covered charges, remaining balances and deductibles that have not been satisfied are the responsibility of the patient and payment is expected at the time services are rendered.
Many insurance’s require an authorization for treatment from your primary care physician, be sure to bring that with you. If you fail, then we ask you to sign a waiver that states you will be responsible for total payment until you provide an authorization for care.
Appointments – (757) 481- 4424
Please call us Monday through Friday, from 8:30 a.m. to 5:00 p.m., to schedule your appointment.
If you find it necessary to change an appointment, please call our office at least 24 hours prior to your appointment time.
We try our best to stay on schedule; however, emergencies sometime arise. If we are seriously delayed, we will try to notify you beforehand. Please assist us by being on time for your appointment. Occasionally we may call patients in the waiting room out of turn if they are urgent cases. We know your time is valuable, and we ask your patience if you have to wait.
If safety concerns due to inclement weather require us to change your appointment, we will call you as soon as possible to reschedule.
Important Phone Numbers –
Appointments / General Info. : (757) 481-4424
Fax: (757) 481-0132
Billing Questions: (757) 481-7708
Medical Records: (757) 481-9458
Medical Records / Privacy Information–
Your medical record is confidential and contains privileged information. We will not release any information about you, without your permission to do so. We have enclosed a Release of Medical Records form you can download and fill out if there is a need to forward information from your record. To help keep your medical record current, please advise us of any changes in your name, address, telephone number or insurance carrier at the earliest opportunity.
Directions
Click on the above link for directions to our three conveniently located offices.
