Patient Forms

Welcome to Kingwood Family Practice and thank you for choosing us!

 

 Patient Forms:

Registration

HIPPA

Health History

Notice of Privacy Practices

Insurance Referral Form

Medical Release of Information

 

 

Insurance Policy:

Our office accepts most major insurance plans (PPO; POS; EPO; MEDICARE; and some HMO’S). We will file your claim directly with your insurance carrier for you as well as verify your benefits. Please keep in mind that a verification of benefits is NOT a guarantee of payment for services rendered. All co-pays; deductibles; out of pocket expenses;  will be due on the date of services at time of check out. Please bring your insurance card on the day of your appointment.

 

Payment methods:

For your convenience, our office accepts Visa; MasterCard; American Express; Discover  as well as cash or checks.

 

 

 

 

 


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