Patient Forms

//Patient Forms
Patient Forms 2018-03-02T10:42:36+00:00

Download, print and fill out your patient intake form at home to save you time once you’ve arrived at OnPoint Urgent Care.

We are committed to giving you the best possible medical care. To achieve this goal, we need your assistance and understanding of our payment policy.

Payment is Due at the Time of Service

  • We accept cash, checks, debit, HSA (with Visa or Mastercard logo) and credit cards.
  • All co-payments, deductibles, co-insurance, and fees for services are due at the time of service unless you have made payment arrangements in advance of your appointment.

Credit cards are collected at the Time of Service

  • We collect credit cards at the time of service and keep on file to charge for any outstanding balance after insurance has processed the claim.  Once insurance has processed the claim a statement will be sent to the patient allowing 14 days for payment to be made by an alternative method if so desired.  If not, the card on file will be charged for the balance due unless payment arrangements have been made in advance.

Proof of Insurance

  • Current insurance cards and a valid photo ID are required for each visit.

Self-Pay Accounts

  • If a patient is not covered by insurance, has a plan that we do not participate in, does not have a valid insurance card on file or declines to provide a social security number, they will be considered a self-pay patient and should be prepared to pay a minimum of $228 on the date of service.  There may be additional fees for in-office procedures, labs, x-rays, medications, crutches, splints, or other supplies or services.