We know that going to the doctor’s office can sometimes be stressful and you likely will have many questions. Our goal is to make you as comfortable as possible about your visit so you can focus on what’s most important – your health!
To this end, we’ve put together the resources on this page with links to downloadable, printable forms that you’ll need. Please take a minute to find the information most relevant to your visit, and if you have any questions please feel free to contact us: (413) 562-5173
We also have a FAQ
Become a New Patient
We are currently accepting new patients into our practice. Thank you for considering us. To become a new patient:
When you come to our office for the first time as a new patient please bring with you the completed forms that you downloaded (above) that were included in the New Patient Packet. If you were not able to download, print and complete them prior to your visit, you will be given these forms to complete upon arrival. In this case, we ask you to arrive at least 15 minutes prior to your scheduled appointment to give yourself time to fill out these very important forms.
Remember to bring:
- Your health insurance card
- Valid photo ID
- List of current medications and supplements
- Office Co-pay
We understand that your time is important and our staff makes every effort to stay on schedule. Our providers do, however, take as long as necessary to provide the best possible care for every patient, so wait times may apply. If you aren’t able to wait (in case your provider is delayed in seeing you) your appointment may need to be rescheduled.
The same applies for patients who arrive late for an appointment. We’ll make every effort to have you seen by your provider, however, you may need to reschedule.
Patient Consent Form (PDF) – All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility.
Patient Authorization form PHI – Records in (PDF) – Details financial responsibilities regarding preventive medical visits.
Patient Authorization form PHI – Records out (PDF) – Allows patients to authorize the disclosure of their health information to a designated individual, company, agency, or facility.
HIPAA Authorization Form (PDF) – All patients must provide their consent for treatment, communications (calls, emails, and text messaging), and agreement of financial responsibility.
Patient Attendance Policy (PDF) – Details financial responsibilities regarding preventive medical visits.
Financial Policy (PDF) – This form advises patients of their complete financial responsibility for all medical services received without regard to insurance eligibility or coverage determinations.
Notice of Privacy Practices (PDF) – Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
Copay or No Copay(PDF) – Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
Referral Information (PDF) – Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
Insurance Information (PDF) – Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
Patient Responsibilities and Rights (PDF) – Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
Physicians On-Call (PDF) – Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
Controlled Substance Agreement (PDF) – Describes how health information about you (as a patient of this Care Center) may be used and disclosed, and how you can get access to your individually identifiable health information. Please review this notice carefully.
Understanding Your VisitY ou may be wondering what the differences are between the several types of appointments, or visits that we routinely offer. For example, you may be scheduled for a:
- Welcome to Medicare Preventative Visit
- Wellness Exam
- Pre Op Visit
- Post Hospital Visit
- Chronic Care Visit
Many patients find the differences between these services a bit confusing. It’s understandable! Keep in mind, however, that the services performed during each of these visits are different. Your deductibles and co-pay might vary for different types of visits depending on the type of insurance you have.
At Family Medicine Associates we believe that it’s our job to help you understand the different types of office visits we offer so you know what to expect. Below, you’ll find descriptions of each type of visit, as well as the services provided. For information about what your insurance may or may not cover, please contact your insurance company prior to scheduling an appointment.
Physical (Also known as ‘Administrative Physicals’)
Purpose: When you need a doctors or Certified Provider to fill out forms required for camp physicals, school physicals, work physicals, FAA Flight Physicals , insurance physicals and such. Services provided during this visit is geared towards filling out the forms.
Does Not Include: Medication/Prescription refills or evaluation of new problems.
Insurance Coverage: May be covered by insurance, but not always. For Administrative Physicals, there is a fee to fill out the form and that fee is typically not covered by insurance.
“Welcome to Medicare” Preventative Visit
“Welcome to Medicare” Preventative Visit ( also called an Initial Preventive Physical Exam) . You must schedule this introductory visit within the first 12 months of your enrollment in Medicare Part B.
This visit includes a review of your medical and social history related to your health and education and counseling about preventive services, including these:
- Certain screenings, shots, and referrals for other care, if needed
- Order further tests, depending on your general health and medical history.
- Record and evaluate your medical and family history, current health conditions, and prescriptions.
- Height, weight, and blood pressure measurements
- A calculation of your body mass index
- A simple vision test
- A review of your potential risk for depression and your level of safety
- An offer to talk with you about creating advance directives.
- A written plan letting you know which screenings, shots, and other preventive services you need. Get details about coverage for screenings, shots, and other preventive services.
This visit is covered one time. You don’t need to have this visit (i.e., it’s not mandatory) to be covered for yearly “Wellness” visits.
Does Not Include: Medication refills or evaluation of new symptoms.
Insurance Coverage: Medicare covers this visit. You pay nothing (no CoPay) for your “Welcome to Medicare” preventative visit or the yearly “Wellness” visits. If additional tests are performed or receive other medical services during this visit that aren’t covered under these preventative benefits, you may have to pay coinsurance and the Medicare Part B deductible may apply.
Following the visit, your doctor will give you a plan or checklist with free screenings and preventive services that you need.
What to bring to your “Welcome to Medicare” preventive visit
Please bring the following (below) with you when you arrive for your “Welcome to Medicare” visit:
- Medical records, including immunization records. Please gather as much medical information as you can.
- Family health history. This information will help you and your doctor better understand what screenings you need to get and what to watch for in the future.
- Prescription drugs. Bring a list of any prescription drugs, over-the-counter drugs, vitamins/herbal supplements that you currently take, how often you take them, and why.
Annual Wellness Visit
If you’ve had Part B for longer than 12 months, you can get this visit to develop or update a personalized prevention help plan. This plan is designed to help prevent disease and disability based on your current health and risk factors. Your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment,” as part of this visit. Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. It can also include:
- A review of your medical and family history
- Developing or updating a list of current providers and prescriptions
- Height, weight, blood pressure, and other routine measurements
- Detection of any cognitive impairment
- Personalized health advice
- A list of risk factors and treatment options for you
- A screening schedule (like a checklist) for appropriate preventive services. Get details about coverage for screenings, shots, and other preventive services.
- Advance Care Planning
This visit is covered once every 12 months (11 full months must have passed since the last visit).
All people with Part B are covered.
Your costs in Original Medicare
You pay nothing for the “Welcome to Medicare” preventive visit or the yearly “Wellness” visit if your doctor or other qualified health care provider accepts assignment. The Part B deductible doesn’t apply.
However, you may have to pay coinsurance, and the Part B deductible may apply if:
- Your doctor or other health care provider performs additional tests or services during the same visit.These additional tests or services aren’t covered under the preventive benefits
Family Medicine Associates participates in the Medicare Accountable Care Organization (ACO).
What to bring to your Annual Wellness Visit
Please download , print and fill out the Annual Wellness Visit HEALTH RISK ASSESSMENT form. Bring this with you to your visit to review with your provider.
Pre Op Visit
Pre-op is the time before your surgery. Your Primary Care doctor may schedule this visit.
Purpose: It’s highly advisable that this checkup be done within the month before surgery. This gives your doctors time to treat any medical issues that you may have before your surgery date. Your doctor and the entire surgical team need to gather as much information as they can to give you the best possible surgery outcome. During this visit, your doctor will take your medical history. Your doctor will also do a physical exam. We will send all notes, reports and test results to your hospital or surgeon.
Does not include: Review of preventive services.
Insurance: This visit is covered by most insurances, including Medicaid and Medicare.
Post Hospital Visit
The Post Hospital Follow-up visit gives both the patient and the Primary Care Provider the opportunity to address the conditions that led to the hospitalization/admission and to prepare the patient and/or caregiver(s) for the transition to self-care. This visit is very important for recently-discharged patients to prevent unnecessary readmission.
- Prior to the visit: Be sure that if needed, you have made transportation arrangements. It is important – before you leave for your appointment – to gather all of your prescription (and over the counter) medications, as well as nutritional/herbal supplements, and medications lists. During this time ‘Post-Discharge’ but before your Post Hospital Visit, you should already have written instructions for seeking both Emergency and Non-Emergency after-hours care. If you don’t have such information, please call us as we will be happy to assist.
- During the visit: Your doctor or provider will discuss your medications in detail. He/she will review and compare your pre-hospitalization medication regimen against your new medication regimen/list stated on your hospital discharge summary for accuracy, discrepancies, and modify if necessary. He/she will want to make sure that you completely understand the instructions you received from the hospital for managing your medications and your condition. Your Provider will make sure that you are aware of ‘Red Flags’ , or warning signs or symptoms that may indicate a worsening condition. He/she will explain your options for seeking care during regular office hours, as well as evenings/weekends.
- After the visit: If any modifications to your care plan or medications have been made by your Provider, he/she will ensure that the changes are understood by the patient. A new list will be printed as reference the patient, and the updated care plan instructions/mediation list will also be conveyed to other health care professionals involved in the patient’s overall care such as home health care nurses, family caregivers, etc. The patient will be instructed with a date or time to follow up by phone or in person.
Chronic Care Visit
Purpose: Sometimes called a ‘Follow Up’ visit. Review of chronic problems associated with a single condition or illness. Decisions about medication adjustments, review lab results, and/or prescription refills are made during this visit. For some simple chronic problems (i.e., allergies), this may be once a year. For more serious or urgent health conditions, your doctor may want more frequent visits.
Does not include: Review of preventive services.
Insurance coverage: This visit is covered by most insurances, including Medicaid and Medicare.