Patient Information

Patient Forms
Access and download all necessary patient forms here to save time and ensure your visit is quick and efficient. Click on the name of the form in the list below to download it.
* New Patient Intake Form
* Medical Disclosure Form
* HIPPA Privacy Authorization Form
* Insurance Coverage Waiver

Medications

Medicare

Cancellations / No-show appointments

Insurances

● The first few months of the year we all know we have an insurance deductible that has to be meet so we are going to be asking you plan on paying your deductible at your office visit. If you have met the deductible then we will asking for your copay before you are seen for your appointment.


● Any balances that you may have at the time of your visit will also be requested at this time. If you have to large of a balance to pay all at once we do offer payment plans. Make sure you setup some form of payment arrangement so we won’t have to send you to our third party collection company.


● Every Year you are required by your insurance to get a Well visit or Physical Exam. Dr. Bragman provides a Executive Physical Exam which includes a Pulmonary Function Test, X-ray, EKG and Lab work. Most insurances will cover the visit charge itself in full however many insurance companies don’t always cover the PFT, X-ray or EKG and may apply the amount to your deductible. When you come in for your physical we will hand out a piece of paper that gives the charge amount of each test. It will be up to you if you decide to get these tests. Just understand that if your insurance doesn’t pay for those charges you will be responsible for any remaining cost.