Forms & Payment
Accepts new patients
| Medicare | Medicaid | Workers' compensation | Other |
|---|---|---|---|
Medical insurance plans and payment options
We accept all patients. However, you will need to check with your insurance provider to confirm we are on their plan. We are affiliated with nearly all local insurance plans.
Please discuss billing options with our billing staff.
Office information from Orthopaedic Associates of Northern New Mexico, P.C.
A. New Patient InformationAll new patients should print and review this form in order to prepare for their first appointment. Information in this brochure includes "What to expect at your first appointment" and a map to help you locate our office.
B. Patient Medical History
Please print and complete your medical history. Completing this form prior to attending your first appointment will enable you to be seen more quickly by the physician.
C. Patient Information Form
This required form provides the office with your address and contact information. In addition, your signature acknowledges your understanding of select office policies.
D. Financial Policy of OANNM
It is important that you read and understand the financial requirements as a patient with OANNM. Please print, read and sign the Financial Policy form.
E. HIPAA Policy
You are granted certain rights regarding your private information. Please print and read this document to understand your rights.
F. HIPAA Policy Acknowledgment
Please print, read and sign this document for our records. By signing, you state you have read our HIPAA policy and will abide by the policy as a patient of Dr. Bear, Dr. Gossum and Sean Wilson, PA-C.
G. Patient Rights and Responsibilities
The expectations of OANNM in regards to Patient Rights and Responsibilities.