Appointment Information

female9.jpg

Welcome! We look forward to being of service to you and meeting your healthcare needs.

The forms for you to download and bring to your appointment include:

1) Welcome & Consent
2) Social Medical and Surgical History
3) Review of Systems
4) Psychological Health & History Questionnaire
5) HIPAA

IF APPLICABLE :
6) Medicare Signature
7) Motor Vehicle Forms
8) Workers' Comp Forms
9) Dizziness & Vertigo
10) Auth for BRS to Send My Records
11) Auth for BRS to Receive My Records
12) Headache Questionnaire
13a) Amputee Assessment
13b) Amputee - New prosthesis
14) Pain
15) Medications and Allergies

Patients seen at St. Mary Rehabilitation Hospital must also download and complete these forms.

It is important that we have an accurate record of all medications you are currently taking, both over-the-counter and prescription. Please either bring your medication bottles with you to the appointment, OR complete the sheet provided, listing the name (correctly spelled), strength (i.e. 20 mgs), form, route, dose and frequency of both prescription and over-the-counter medications you are currently taking.

Kindly check that your referral has been issued by your PCP before your visit. Be sure to bring with you the prescription from the referring doctor, insurance cards, prescription drug cards if applicable, driver’s license, and any X-ray/MRI/CAT Scan films/CDs, as well as associated reports (if you have them).

Appointment Time/Wait Time

We give each patient our thorough attention and cannot anticipate medical situations which may delay us. Your time is valuable and we do our best to minimize wait time. Each patient and situation is unique however. We offer you the option to reschedule if your wait time is not acceptable.

Prescription Refills

We require 3 business days’ notice in order for prescriptions to be picked up or phoned in. Please take note of the date when your prescription will run out in order to give ample time for your refill request to be handled. Remember we are closed on Saturdays and Sundays.

Test Results

Test results are provided and reviewed at the time of the follow-up appointment, which is normally scheduled for two weeks after Dr. Bernal orders testing. Test results are not routinely released over the telephone.

We continuously strive to improve our service to you and welcome your input. Please let us know how we are doing by filling out a patient satisfaction questionnaire and be entered in a monthly drawing to win a gift card. Thank you very much!