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 that we are on their plan. We are affiliated with nearly all local insurance plans.
Please discuss payment options with our billing staff.
Office information from Robin Sann Gossum, MD
A. New Patient Information brochureNew patient information brochure including: Your first visit to OANNM; Driving directions and map; and the OANNM financial policy.
B. Medical History, page 1
Please complete this form prior to coming to the office.
C. Medical History, page 2
Please complete this form prior to coming to the office.
D. Patient Information Form
Patient Information form provides the practice with demographic information about the patient and the responsible part (if someone other than the patient).
E. HIPAA Policy Part 1
OANNM HIPAA Policy
F. HIPAA Policy Part 2
OANNM HIPAA Policy
G. Patient Rights and Responsibilities
The expectations of OANNM in regards to Patient Rights and Responsibilities.