New Patient Registration

New Patient Registration

Dear Patient,

Thank you for choosing Virginia Spine Specialists for your Spinal Care and Pain Management needs. We know you have a lot of choices in choosing your healthcare providers, and we consider it a privilege to be a part of your health care support team.

Below are some important facts that you need to know in order to facilitate your appointment in a timely fashion.

1.      Please plan to arrive approximately (30) minutes prior to your scheduled appointment to allow time for you and your significant other (if applicable) to sign consent forms that are required for your treatment. Please make sure your New Patient paperwork is completed prior to arriving for your appointment. If you arrive and your paperwork has not been completed “we may re-schedule appointment”.

It is important that your significant other is able to accompany you to your appointments as much as possible, there is a lot of medical information provided and we want to be sure you fully understand the medical opinion being provided.

2.      Please complete the New Patient paperwork and make sure to bring along with you to your appointment the following. If any of the required information is missing your appointment may need to be re-scheduled.

  • New Patient paperwork (required)
  • Driver’s License, (required)
  • Insurance cards, (required)
  • MRI reports and CD’s are preferred if you have them (required)
  • All medical records relating to the treatment you have had for this condition.

In an effort to be HIPAA compliant and to protect your private health information and identity, we require that you bring your photo I.D. and insurance card to your first visit. As a courtesy to you we will submit your insurance claims for you; however any and all co-payments will be collected at time of service.

This information will enable us to thoroughly review your medical background and provide you with the best possible care. If you have been seen by another physician, please request those medical records from the provider directly and bring them to your appointment. *Please note, if you have prior Surgery, we would need to have a copy of the Surgical report.

INSURANCE/REFERRAL/OUT OF POCKET

1.      As a new patient your insurance may require a “Insurance Referral” to be provided in order for you to be seen in our office and prior to testing. We recommend that all patients call and confirm this directly with your health insurance or check with your PCP office ahead of time.  

If an “Insurance Referral” has not been obtained before your appointment, you will be asked to sign a “Waiver Form” acknowledging that if the Referral is not able to be obtained timely I will be financially responsible for the charges incurred.

If you have questions about a Referral or the processing of an existing Referral, please feel free to contact us via phone.  Please allow 24-48 hours for any timely replies.

 **PLEASE NOTE, an Insurance Referral will be provided with an authorization number to be billed with your claim for service, this will generally also have a certain number of visits along with codes. This may not be the same a written Referral from your doctor’s office.

2.      For any noninsured patients, fees for all office visits and related charges are payable at the time of service.

My staff and I appreciate you selecting our office for your health care. We recognize the trust and responsibility placed in us and we will do everything possible to provide for those needs. We look forward to seeing you!

Sincerely,
Dr. Sharma, MD & VSS Staff

Please print and complete 1-3 of the PDFs below.

  1. VSS New Patient Packet (please complete)
  2. VSS Health History (Clinical Intake) (please complete)
  3. HIPPA Patient Privacy Practices (copy for patients)

Any question, please call 855-774-6334