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New Patients

KEY FORMS


WELCOME NEW PATIENTS!

Please come to the office at least 30 minutes prior to your scheduled appointment so that we can complete the necessary paperwork. If you have previous x-rays, etc. please bring them with you or have them sent to us in advance. Continue reading for details...

TO DOWNLOAD NEW PATIENT FORM

To save yourself time registering as a new patient, you can download and print out a blank copy of our Patient Form. Complete it at home and bring it with you to the office to save time registering.

Instructions to download:

Click on the link below to access the New Patient Form. After you click the link, a browser window will open. After it opens, click on the 'PRINT' icon on your browser. After the form prints, fill it out and bring it with you to the office. Completing the New Patient Information Form will save you time on your initial visit!


RADIOGRAPHIC STUDIES (X-rays, MRI's, CT Scans, etc.)

PRIOR TO YOUR FIRST APPOINTMENT:

  1. If this is your first time being seen by Dr. Leavitt for your foot/ankle condition, we may take x-rays in our building. Even if you have prior x-rays, which we would like to have if available on disk, we require a new set of x-rays done to our standards. In most instances, x-rays done elsewhere are sadly inferior to the quality of positioning that we require.


  2. If you are coming for a second opinion or further consultation, the doctor needs to review your prior X-rays, CT scans, MRI's, Myelograms, bone scans, blood studies or prior consultation findings. You should arrange to bring these with you for your first appointment, or better yet download them onto our system in advance of your visit with us. See #2 below.


    1. OPTIONS:
    2. If you don't have copies of your prior X-rays, CT scans, MRI's, Myelograms, bone scans, etc. then to ensure the films and reports are available the day of the appointment, we advise patients to contact the test facility to pick up and hand-carry the films to the appointment. Please be advised that some facilities require pick-up notification several days in advance.


    3. If you already have electronic copies of your prior X-rays, CT scans, MRI's, Myelograms, bone scans, etc. on CD's or on your own computer at home, the link below will take you to the New England Baptist Radiology Department site which has information for on how to upload your images prior to your appointment with Dr. Leavitt
    4. http://www.nebh.org/departments-services/radiology/upload-your-images/

TO REQUEST COPIES OF DR. LEAVITT'S X-RAYS, SCANS, ETC.

  1. Request by Fax: You have a right to request paper or CD copies of our diagnostic images. Please print out the attached request form, fill it out completely, and fax it to the New England Baptist Department of Radiology at 617-754-6463.

INSURANCE INFORMATION

  • Please bring ALL insurance cards with you at the time of your appointment.

  • If your insurance plan is an HMO or managed care plan, the patient is responsible for obtaining a referral from your primary care physician.

  • Referrals must be received in our Brookline office prior to the appointment. You may call in the referral number to 617-277-3800 and paper referrals may be faxed to 617-277-3808. All paper referals must also be mailed to our central office located in Brookline.

  • Co-Payments are accepted at the time of your appointment.

  • If the reason for your visit is work or motor vehicle accident related you must have the name of the insurance carrier, claim number, adjuster name and telephone number the day of the appointment.

DISABILITY FORMS

There is no charge for the first request for the completion of disability forms however, any additional requests will be subject to an administrative fee of $5.00 or more. Payment and a HIPPA compliant authorization form must accompany each request prior to the release of any information.

DISABILITY PARKING TAGS


PATIENT PRIVACY


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