Forms and Policies
Forms
For your convenience, we have made available several standard forms online. Feel free to print off any applicable form and fill out prior to your visit to help expedite your visit.
Patient Registration
Patient Medical History Questionnaire
Privacy Practices and Hippa
Financial Policy
Upper Lower Extremity History
Policies
Appointments
We request that you provide 48 hours notice if you must cancel an appointment.
Patients under the age of 18 must be accompanied by an adult or legal guardian. Consent forms are available so minors can be seen alone on follow up visits. Please ask for one if you will not be able to accompany your child for each appointment.
Medical record privacy
Your medial record is confidential. It will not be given to anyone without your written consent. If necessary, please ask our business office staff to provide you with a release of information form. Our practice adheres to all HIPAA regulations.
Prescription refills
Prescription refills may be obtained, when appropriate, by calling the office during regular office hours. We recommend that patients maintain an awareness of how much medication they have left, as prescription refills cannot be authorized on evenings or weekends. The doctor cannot renew prescriptions for medications written by other physicians outside of this practice. We require 24 hour notice for refill requests.
Insurance/fees
Dr. Kefalas participates in most major insurance plans. Our office will gladly submit claims to your insurance company for reimbursement. Please pay co-payments and any balances due at the time of your visit. For your convenience, we accept Visa, MasterCard, Discover, debit cards, cash and checks. Our billing office is available to assist you with financial questions. A copy of our Practice Financial Policy will be provided to you and is also available on our website.
Workers compensation cases
Central Illinois Bone & Joint Center will coordinate claims with the appropriate workers compensation carrier. It is the responsibility of the patient to inform Central Illinois Bone & Joint Center of the applicable carrier and case status.
Terms and Conditions
Forms
For your convenience, we have made available several standard forms online. Feel free to print off any applicable form and fill out prior to your visit to help expedite your visit.
Patient Registration
Patient Medical History Questionnaire
Privacy Practices and Hippa
Financial Policy
Upper Lower Extremity History
Policies
Appointments
We request that you provide 48 hours notice if you must cancel an appointment.
Patients under the age of 18 must be accompanied by an adult or legal guardian. Consent forms are available so minors can be seen alone on follow up visits. Please ask for one if you will not be able to accompany your child for each appointment.
Medical record privacy
Your medial record is confidential. It will not be given to anyone without your written consent. If necessary, please ask our business office staff to provide you with a release of information form. Our practice adheres to all HIPAA regulations.
Prescription refills
Prescription refills may be obtained, when appropriate, by calling the office during regular office hours. We recommend that patients maintain an awareness of how much medication they have left, as prescription refills cannot be authorized on evenings or weekends. The doctor cannot renew prescriptions for medications written by other physicians outside of this practice. We require 24 hour notice for refill requests.
Insurance/fees
Dr. Kefalas participates in most major insurance plans. Our office will gladly submit claims to your insurance company for reimbursement. Please pay co-payments and any balances due at the time of your visit. For your convenience, we accept Visa, MasterCard, Discover, debit cards, cash and checks. Our billing office is available to assist you with financial questions. A copy of our Practice Financial Policy will be provided to you and is also available on our website.
Workers compensation cases
Central Illinois Bone & Joint Center will coordinate claims with the appropriate workers compensation carrier. It is the responsibility of the patient to inform Central Illinois Bone & Joint Center of the applicable carrier and case status.
Terms and Conditions