Forms/Billing
Forms:
Demographic Form
History Form Page 1 Form
History Form Page 2 Form
Pain Intake Form
Consent Form
(Abobe Acrobat Reader is required,
please download here: Download Link)
Billing:
What insurance do you take?
IN NETWORK PARTICIPATING INSURANCES:
BCBS HMO/PPO, AETNA HMO/PPO/POS, UNITED/OXFORD, QUALCARE HMO/PPO, AMERIHEALTH, MEDICARE, CIGNA, BEECHSTREET, MULTIPLAN/PHCS
we collaborate with many insurance companies. Please check with your insurance carrier regarding our participation and your responsibility for referrals, co-payments, etc. If it is determined that Dr.Balar does not have a partnership with your insurance company, payment is required at the time of your visit. Please note that if you have Medicare and your spouse is employed, the insurance of your spouse is your primary insurance. Payments are required before the office visit and can be made via cash or check.
