Free Back Surgery Guide!
To understand what your options are for spine surgery, download our article
"The Patients Guide to Spinal Fusions, Decompressions and Failed Spine Surgery"
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This form is also available as a printable PDF: New Patient Form (Print)
Welcome to Great River Spine. To expedite your chart preparation, please have the form below filled out completely & submitted successfully (you will be taken to a confirmation page upon submission). The receptionist will need to have a copy of your driver’s license and insurance card at the time of your visit.
Please note the following:
- X-rays/MRI’s/CT scans etc. :
1. Please bring your X-Rays, MRIs, and/or CAT Scans with you to your appointment. Having the studies put on a CD Rom is acceptable.
2. If these studies have been done at Great River Medical Center we will arrange to have them here for you.
- Insurance: Bring your insurance card with you so that our receptionist can make a copy. You are responsible for your co-pay or percentage (10-20 %…) that your insurance will not pay, at the time of your visit.
- Worker’s Compensation: You will need to supply us with your employer information, date of accident, WC insurance company name, address of where to mail claims, and a claim number.
- Motor Vehicle Accident: We apologize, but our doctor does not file on auto insurance.
- Medicaid: Before seeing a specialist, Medicaid requires that you obtain a Medicaid referral from your PCP (primary care physician). If this is not obtained, Medicaid will not pay your specialist, and you will be responsible for the bill; therefore, if you have not obtained a referral, we require you to pay for your visit in full at the time of service.
- No Insurance: You will be responsible for full payment of your visit at the time of service.
- Medications: No medications are dispensed out of this office without Dr. Foster’s approval. Please allow 24-48 hours for medication refill requests, as Dr. Foster is in surgery 2 days per week and needs adequate time to approve requests.
- Cancellations: Please be considerate and notify our office 24 hours prior to your appointment if you need to cancel or reschedule, as there may be other patients needing that appointment time.
- If you are unable to comply with any of the above, please call our office prior to your visit to discuss these requirements.