New Patients

We are so pleased that you have chosen Jupiter Hand to Shoulder for evaluation and treatment of your upper extremity problem.


SCHEDULING YOUR APPOINTMENT

In order to help us deliver the highest quality of care, please be prepared to provide the following information when you call to schedule your appointment:

• Legal Name (Nickname if Applicable)

• Date of Birth

• Mailing Address

• Insurance Information including Primary and Secondary Insurance Plans, Member #, Group #, and Policy #

• Referring Physician, if applicable

• Reason for Scheduling a Visit (for example, finger locking, hand numbness, wrist fracture, shoulder pain, etc.)

• Credit card to hold the appointment (we accept Visa, Master Card, and American Express). Be advised that Jupiter Hand to Shoulder charges a $50 fee for patients who do not show up for their scheduled appointment. Please cancel any appointment at least 2 business days prior to avoid this fee.


YOUR FIRST APPOINTMENT

It is important that you bring the following materials to your appointment:

• Insurance Cards

• Driver License or other form of Identification

• Emergency Contact Information

• List of Medical Problems

• List of Medications

• CD containing any imaging relevant to your condition as well as the accompanying report

• Any medical records related to prior evaluation, surgery, or other treatment for your condition (i.e. operative reports, physician office notes, therapy evaluation and progress notes, etc)

• Cash, Personal Check, or Credit Card for payment of any copayments or coinsurance due at the time of service.

We strongly encourage you to download, print, and complete the forms below, and bring them with you to your appointment. This will help expedite your care.

JHS Notice of Privacy Practices

JHS New Patient

Assignment of Benefits/Acknowledgment of Receipt PHI

JHS Controlled Substances Policy

JHS Medical History

Problem-Specific Intake Form