Hand Surgery of Northern Michigan

Patient info

Welcome to Hand Surgery of Northern Michigan. We are looking forward to seeing you and would like to provide you with the following information.

Appointments

Patients are seen by appointment only. To schedule an appointment please call during our regular business hours. If you must cancel your appointment, please notify us at least 24 hours in advance and we will be happy to reschedule your visit. Your first appointment is for an initial visit / consultation only. In most cases, surgery will not be performed at the time of this visit but will be scheduled for a later date. Out of courtesy to our scheduled patients, we cannot accommodate walk-ins. When possible, please restrict accompanying family members to one person

Initial Visit

To help us make your first appointment a success, please bring the following to your appointment:

• Insurance card (and insurance authorization, if needed)

• Photo ID

• Medical records, including any tests (i.e., x-rays, EMG, MRI, CT scan), for the condition being seen. If your studies were performed at Munson Medical Center or any affiliated facility, we are able to access those and it is not necessary to bring them with you.

• Completed New Patient, History and Physical, Patient Medication List , Allergy Questionnaire and Authorization to Treat forms (or complete on our Patient Portal)

• Completed injury authorization (Workers Comp, Auto, or Liability) form, if applicable. If your visit is related to an auto, Workers Comp or a liability issue, we require written authorization. If an authorization is not available, we will require payment in full at the time of service.

• Social Security number. It is our policy that if you do not wish to provide us with your social security number, we will ask for payment in full at the time of service, regardless of insurance coverage.

For patients under the age of 18, it is our policy that they be accompanied by a parent or legal guardian for their initial appointment with our physicians. If the parent or legal guardian is not available, the patient must have written permission for treatment. Our Parental Preauthorization (see below) form may be used for this purpose. If a child comes to an initial physician appointment without a parent/guardian or written permission for treatment, their appointment may be re-scheduled.

Please be advised that in adherence with our financial policy, we require payment in full for all charges at the time of service OR payment of co-pays and deductibles for patients covered by Medicare, Blue Cross Blue Shield, or Priority Health. We will reschedule appointments for patients who are not prepared to pay. If you do not know your co-pay, we will collect $30.00 at your visit. Cash, check and credit cards are accepted. As a courtesy for our patients, we will file your claim into your insurance carrier.

Patient Survey

Please fill out our patient survey.
Patient Survey

Forms / Policies

Patient Portal (contact our office for instructions)

New Patient Registration Form

Authorization to Treat
(Download form
if not entered in Patient Portal link)

Workers Comp Authorization
(Download form
)

Auto Liability Authorization
(Download form
)

Liability Authorization
(Download form
)

Parental Authorization for Treatment of Minors
(Download form
)

Records Release Form
(Download form
)

HIPAA Privacy Notice
(Download form
)

Community Registry Authorization
(Download form
)

Medication & Allergy List
(Download form
)

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701 W. Front Street, Suite 100, Traverse City, MI, 49684       Ph. 231-935-0800       www.hsnmi.com