Beacon Healthcare Associates - Internal Medicine and Primary Care for Adults

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Become a New Patient
We welcome new patients.  We are in network with the following insurance companies: Aetna, Blue Cross Blue Shield of NC, Cigna, Crescent, First Health, Humana, Medcost, Medicare, Medicare Replacement Plans, Railroad Medicare, Tricare, and United Healthcare.  While we do participate with NC Medicaid, we are not currently accepting new Medicaid patients.

In order to schedule a new patient appointment we ask that you do the following:

Step 1 -- Complete the below New Patient Registration Form and submit it to our office.  Alternatively, you can print out a copy and mail it to our office with your Health History Questionnaire.  Once we receive it, someone from our office will contact you to schedule an appointment.

Step 2 -- Please print out, review, sign and bring in the following forms -- Welcome to Beacon Healthcare Associates, Financial Policy, Office Communications Policy, HIPAA policy, and Pain Management for New Patients Policy (if this should apply to you).  If you would prefer to review them directly with one of our staff members before actually signing them, you are welcome to print them out and discuss any questions you may have as you check-in for your first appointment.  You will be asked to sign a Reassignment of Benefits form as you check-in for your first appointment as well.

Step 3 -- Print out and complete our Health History Questionnaire and Request for Medical Records forms.  Bring these with you to your first appointment.  Note, we may need to reschedule your first appointment if you do not bring your completed Health History Questionnaire with you.  You are welcome to drop them buy or put them in the mail, if you have time.  Also, for medical record requests, we ask that you bring in contact information, including fax numbers, for other current or previous providers.

Step 4 -- If you do not have health insurance we ask that you send in a $200 deposit in order to schedule a first appointment.  You can do this by going to our Make A Payment page where you can make a credit card, debit card or Paypal payment.  Or, you can mail in a $200 check.  Please know that if you are unable to keep your first appointment or the actual cost of your first appointment is less than $200, we will give you a refund for any credit balances on your account.  Please know that we do expect 24 hour's notice of cancellation.  We charge a $5 fee for less than 24 hour's notice and a $15 fee for failure to keep a scheduled appointment.  We would take these fees out of any credit balances prior to issuing you a refund.

Step 5 -- If your insurance plan is not included on our list, please mark "Other" and someone will contact you to discuss whether the care you receive in our office will be covered by the plan you do carry.  We cannot accept patient's covered under a Worker's Comp or Accident Liability Claim without prior authorization from the Worker's Comp or Accident Insurance company.  If you indicate "yes" for either of these options, someone from our office will contact you to get relevant information about the claim so we can seek such authorization.

Please do call our office if you have any questions about how to complete these steps or becoming a New Patient in general.  We can be reached at (828) 254-4899.

New Patient Registration Form

Please complete all fields of this form and submit to the office.  Someone will contact you within one business about scheduling an appointment.

First Name:
Middle Initial:
Last Name:
Gender:
Date of Birth:
Social Security Number:
Mailing Address:
Address Line #2:
City, State, Zip Code:
Home Telephone #:
Work Telephone #:
Cell Telephone #:
Best Contact #:
May we leave confidential medical information on voice mail? Please write in "yes" or "no":
If yes, at which number(s)?:
Email address:
May we send confidential medical information to this email address even if it is not secure? Please write "yes" or "no":
Are you?:
Are you?:
If Employed or Retired, Name of Employer:
Primary Insurance Carrier:
Name of Insured:
Insured's Date of Birth:
Insured's Social Security # (if not patient):
Patient's relationship to insured:
Primary Insurance ID #:
Primary Insurance Group #:
Do you have a secondary insurance?:
Do you have a third insurance?:
Are you covered under a Worker's Comp claim?:
Are you covered under an Accident Liability claim?:
Emergency Contact Person:
Emergency Contact's Telephone #:

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