Patient Responsibility

It is the patient or guardian responsibility to:

Arrive on time for the appointment, with all necessary information.

Repeated no shows or cancels may result in a fee to the patient.  We need adequate time to contact patients on the wait list if you need to cancel or reschedule.

Provide current insurance information.
If you have insurance, please refer to the the Insurance tab for all of the details!  

Provide completed and signed forms when requested.

  • completed registration forms
  • written referral if required by your insurance
  • insurance cards
  • photo identification
  • co-pay

Notify our office of any changes in name, address, phone and insurance before each visit.

Provide referrals if required.
Please refer to Referrals under the Insurance tab for details!


Stop at the Check Out Desk after your appointment. We will:

  • collect your co-pay
  • schedule follow-up appointments
  • have you sign Medical Release forms if necessary
  • provide written Rx to you if necessary
  • provide written excuses to you for work or school if necessary

Pay co-pay:  Copays are due at the time of your visit.
For your convenience, we accept the following forms of payments:

  • MasterCard
  • Visa
  • Discover
  • American Express
  • Check
  • Cash 

Pay Patient Balances:
You can refer to the back of your statement for billing policies.

Payment in full is due upon receipt of your first bill. We are happy to work with you and extend special payment arrangements to you if you have a larger balance and are not able to pay in full by the due date. We do request that you call upon receipt of your first bill. It is important that we note your account as on a payment plan to avoid aging and moving to collections, even if you are making partial payments. So please call!

 

 

 

 

 

 

 

 


 

 

 

 

 

 

Copyright © 2017 Laura Wagner, MD. All Rights Reserved.
14377 Woodlake Dr. #111 • Chesterfield, MO 63017
314-434-1111