Forms

Accepts new patients

Medicare Medicaid Workers' compensation Other
Yes No Yes Yes

Medical insurance plans and payment options

It is the responsibility of the patient to pay for medical treatment. Insurance is filed as a courtesy to patients. Payment is due at time of service. However, no one will be denied urgent care due to inability to pay. This office participates in most health insurance plans.

As a convenience to our patients, we will file all insurance claims, primary and supplementary. Patients, insurance companies and doctor's offices can make mistakes, and it requires the assistance of all three parties to make the process go smoothly.

Worker's compensation claims are verified with the employer or their compensation carrier. The address, claim number and authorization of the compensation carrier, not the employer, are required for treatment. Patients will not receive a bill unless the claim is denied by the employer or the carrier. In that case, the patient will be responsible for all medical expenses.

We realize that medical care can be quite expensive and that patients are frequently out of work due to their injury or illness. If you anticipate financial problems, please contact our billing staff to make appropriate arrangements. When no payment is made on account after 90 days, it is considered delinquent and special attempts to contact the responsible party will be made.

HIPAA Policy

Acknowledgement of Privacy Notice
For new patients - signature required

Medical Record Release Form
If you need your medical records released to another provider, please fill this out completely and send back to our medical records department.

Privacy Practices Notification
Our privacy policy / HIPAA compliance

Office Forms and Information

Dr. Thoms Hip Form
Please fill this form out if you will be having a Hip Replacement Consultation with Dr. Thoms.

Dr. Thoms Knee Form
Please fill this form out if you will be having a Knee Replacement Consultation with Dr. Thoms.

Dr. Thoms Shoulder Form
Please fill out this form if you will be having a Shoulder Replacement Consultation with Dr. Thoms.

Financial Policy
For new patients - signature required

Medical History Form
Annual form for Dr. Carlow and Dr. Wei patients

Medical History Form for Dr. Thoms
This is the Annual Medical History form for Dr. Thoms patients to use.

Medication List Form
For all patients

Surgical Financial Policy
This form is for those scheduling surgery. Please sign and return to the office prior to scheduling date of surgery.

Contact Information

Seacoast Orthopedic Surgery & Sports Medicine 495 Route 184 Suite 300 Groton, CT USA 06340 View map Phone 860-449-1413 Fax 860-449-0390
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