Personal Injury / Motor Vehicle Injury

Home | Patients | Finances and Insurance | Personal Injury / Motor Vehicle Injury

(804) 523-8010

Due to the complex nature of the medico-legal arena, detailed documentation is essential for successful settlement outcomes. Therefore, our paperwork for these cases is very thorough and, as a result, lengthy. Patients are encouraged to come in a day ahead of their proposed appointment in order to fill out our intake paperwork as well as to allow sufficient time to collect all appropriate documentation. Required documentation must be received BEFORE the patient will be scheduled officially for an appointment. The following is a list of financial options with required documentation for each option for the filing of injury claims. A patient may ONLY choose ONE of these options:

1	The patient has an attorney retained who will honor a settlement lien on any unpaid case balance.
	A	Attorney's name, phone number, fax number, and address.
	B	Police Report
	C	Picture I.D. (driver's license)
	D	Signed Lien (our office will provide the form for you to sign and we will fax to your attorney. Attorney agrees to the lien by signing and faxing back to us).
	D	# 5. If the attorney does not agree to sign the lien we will accept a retainer check as security instead of the lien. The patient writes a $1500.00 check to be held for one year or until patient receives payment for said claim, whichever occurs first. If a patient receives payment and does not reimburse our office within 15 days, then the check will be cashed and any credits or monies owed will be forwarded to the patient. If the deposit check does not clear the bank, it will be turned over to authorities to be criminally and civilly prosecuted.

2	The patient has health insurance that would pay for treatment costs. The patient would have to agree to our office policy for health insurance acceptance. Any and all amounts not honored by your health insurance plan would become the responsibility of the patient.
	A	See Insurance 101 at top of page and follow instructions.
	B	Police Report
	C	Health Insurance Card
	D	Picture I.D. (driver's license)
	E	Referral, if required.

3	The patient gives a $1500.00 retainer check to be held for one year or until patient receives payment for said claim, whichever occurs first. If a patient receives payment and does not reimburse our office within 15 days, then the check will be cashed and any credits or monies owed will be forwarded to the patient. If the deposit check does not clear the bank, it will be turned over to authorities to be criminally and civilly prosecuted.
	A	Police Report
	B	Picture I.D. (driver's license)
	C	Retainer check

4	Patient has a large enough med pay on their auto insurance to cover the proposed treatment plan and the patient agrees to sign a lien for direct reimbursement to our office.
	A	Copy of Auto Insurance Policy cover page. This lists med pay, which is the maximum amount of coverage you have purchased for medical payments.
	B	Claims adjuster name, address, phone number with extension, fax number, and claim number.
	C	Picture I.D.
	D	Police report
	E	Signed lien or retainer check (see option 3) or choose another payment option.

5	Patient pays for each service and can be directly reimbursed from their health or auto insurance carrier or injury claim settlement.
	A	Police Report
	B	Picture I.D. (driver's license)

When we have received all required documentation, Contact Us to schedule your first appointment. Use our convenient on-line registration form to save you time at your first appointment.

Virtual Tours

Driving Directions

Print this page

Patients

Locations

Doctors

Staff

Virtual Tours

Treatment Hours