New Patient Forms

New Patient Welcome Packet

Policies and Procedures Receipt and Acknowledgement

Release of Medical Records

Adults - New Patient History Form

Adolescents - New Patient History Form

Patient Facesheet Agreement

Sheridan Medical Group participates inCommercial and Medicare lines of business only. We do not accept Medicaid or Medicaid Managed plans.
If you are thinking about changing your insurance plan, please contact us first to make sure we participate before making the switch.

SMG participates with:

• Aetna
• Blue Cross
• Cigna/MVP
• Excellus
• Highmark
• Humana
• Independent Health
• Medicare
• Meritain Health
• Nova
• United Healthcare Medicare Advantage
• Univera

To make an appointment, please visit your Patient Portal and send an appointment request.

Or, you may call our office at 332-4476 during regular business hours.

Our staff makes every effort to keep the providers’ schedules on time. If you are more than 15 minutes late for your appointment, you may be offered the option of waiting for the next available time slot or rescheduling to another time.

Due to the current COVID-19 outbreak, we are temporarily suspending walk-in hours in an effort to prevent further outbreak of this disease.  Please utilize your patient portal or call us by phone of you are not feeling well.

Cancellations

In order to be respectful of the medical needs of our patients, please be courteous and call Sheridan Medical Group promptly if you are unable to attend an appointment.  This time will be reallocated to another patient who is in need of medical care.  This is how we can best serve the needs of all of our patients.

If it is necessary to cancel your scheduled appointment we require that you contact us one (1) business day in advance.  Appointments are in high demand, and your early cancellation will give another patient the ability to have access to timely medical care.

No Show Policy

A “no-show” is the term we use when a patient misses an appointment without cancelling it within one (1) business day in advance.  Unfortunately, “no-shows” inconvenience those patients who need access to medical care in a timely manner.

A failure to attend your scheduled appointment will be recorded in your medical chart as a “No-Show”.  In order to cover the administrative/clinical costs associated with preparation for patient appointments

(e.g. review of medical history, labs, and other pertinent health information) in conjunction with the inability to fill your appointment slot with another patient, an administrative fee of up to $135.00 will be billed to your account.  A letter will be sent informing you of your missed appointment with a bill for the administrative fee enclosed.  A copy of the letter will be placed in your medical record. 

No-show charges are patient responsibility and will not be billed to your insurance company

IDENTIFICATION

In the interest of protecting against identity theft, we require each patient to present a valid and current insurance card as well as a valid picture ID. A copy of your ID will also be scanned into your medical record.

INSURANCE CO-PAYS/OFFICE PAYMENTS

Patients are responsible for co-pays or office charges at the time of service. There will be an additional fee of $10 for all co-pays not paid on the day of the appointment.

We accept cash, checks, and most major credit cards. A $35 fee will be charged for a returned check.

UPDATED MEDICATION LIST

TEST RESULTS

Please bring copies of any x-rays, lab results or any other reports you’ve received from specialists since we last saw you

PEDIATRIC PATIENTS

Children under 18 years of age must be accompanied by a parent or legal guardian. A designated family member or friend may accompany the patient if consent has previously been signed and entered into the patient’s chart.”

Please leave your referral requests on our referral line and include the following:

• your name
• your insurance ID number
• diagnosis or reason for needing the referral
• the specialist’s name and location
• appointment date and time

All requests should be addressed within 3 business days.

Referrals are given at your physician’s discretion.

We understand that various forms or letters may be required to assist you with your healthcare needs.  Forms and letters will be completed as necessary upon your request.  However, because this can be time consuming, please allow 7-10 business days for completion of requested forms.

The charges for completion of these forms are as follows:

• If Form can be printed directly from the appointment summary at checkout – no charge.
• Forms that are 1 to 3 pages long - $10.
• Forms that are more than 3 pages - $20.
• The payment is due prior to the completion of the form.

• Billing statements are executed on the 15th of the month.
•  You have 30 days from the date of the first issued statement to pay your bill.
• On the 31st day, if you have not paid your bill, another statement will be sent with the 1st reminder letter. This will incur an additional charge of $5.00.
• On the 61st day, if you have not paid your bill, the final statement will be sent with another added charge of $5.00 and the final reminder letter will be included. This letter will ask you to pay the balance in full or to establish a payment plan within the next 30 days, or  your balance will be released to a collections company and we will no longer provide professional services. 
• On the 91st day, if you have still not paid your bill or established a payment plan, your account will be sent to collections, a 25% collection fee will be added to your account balance and you will receive a discharge letter.

Billing Questions

If you have billing questions, please call our billing company, Health Tec Solutions, at 716-639-0155

Due to a large number of studies that are done on a daily basis, we generally do not call every patient with test results if all are normal. In the event that there is a test result that requires additional attention, you will be contacted by our office staff. All test results must be reviewed by a provider before any abnormal results can be relayed to you from our nursing staff.

Refills on your medications should be requested during your regularly scheduled appointments, so be sure to anticipate this at each visit.

Refill requests can be made through your pharmacy. They have access to the electronic prescribing system and this is often the fastest and most efficient way to get refills when you do not have an upcoming appointment with us.

If you need to call the office for a refill, we cannot guarantee that it will be done before two business days. Please take into consideration and anticipate when your refills are due.

If you have not had a recent appointment, we may require you to schedule a follow up visit before we can continue refilling a particular medication. This is for your safety and protection.

Narcotic Refills:

Narcotics will never be refilled by phone. Additionally, these must be picked up in person at the office and a signature is required. Please do not call outside of regular office hours for narcotic refills because we will be unable to fill them for you.

We will gladly forward copies of your medical records for a small fee. All requests will be completed within 7 to 10  business days.