Patient Forms
Office Hours
Monday - Thursday: 8:00am - 5:00 pm
Friday: 8:00am - 2:00pm
For New Patients:
New Patient Questionnaire
Please submit your form at least 1 day prior to your appointment.
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Your information will be transmitted to our office securely |
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You can print the form, complete it and fax it to 806-212-0355 |
Office Information
* The doctors of Amarillo Surgical Group are all Board Certified and limit their practice to surgical problems in their specialty
HOSPITALS
Our Surgeons practice only at BSA Hospital.
PLEASE INFORM US IF YOUR INSURANCE REQUIRES THAT YOU GO TO A CERTAIN HOSPITAL
APPOINTMENTS
Our office is open Monday through Thursday from 8 AM to 5 PM and Friday from 8 AM to 2 PM. An appointment is needed to see the doctors, as each has specific times to see patients in the office, and spends a majority of the time in surgery or at the hospitals.
PATIENT CALLS
In order for our staff to handle all the calls that come in, please let us know when you call how we may help you.
EMERGENCIES
In case of medical emergency please call our office at our main number (806) 212-6604, day or night. Please give the office all requested or pertinent information. At times the message may need to be relayed to your physician during surgery.
PAYMENT
We expect any amounts not covered by insurance to be paid at the time of service. If you do not have insurance coverage, please speak to our Patient Accounts office to make payment arrangements or see if you qualify for financial aid.
INSURANCE
We will bill your insurance directly or provide you with a claim form which you may attach to your own insurance form and submit to your carrier. We are participating providers with several networks. If your insurance plan requires that you see only participating providers, please verify before your appointment that we are providers for your plan. Also, if your plan requires a referral you will need to bring that to your appointment.
MEDICARE
We participate with Medicare which means we accept Medicare assignment. After Medicare pays, we will file your supplemental insurance and/or bill you for the remaining 20% that Medicare does not pay.
OUTPATIENT TESTS
If your evaluation includes x-rays, lab, or other tests, these will be done as an outpatient at another facility and you will receive a
bill from that facility and from the doctor who interprets the tests. If your insurance requires the use of a specific facility, please let
us know.
CONFIDENTIALITY
We require your written consent to provide your protected healthcare information to any outside party.
PRECERTIFICATION
In the event that you are scheduled for Surgery or Admission to the Hospital, our staff will contact your insurance company for precertification. We will need to make a copy of your insurance card that has a telephone number and an address to mail your
claim to.