Medical History Form
In advance of your visit, please complete the Patient Medical History Form and bring it with you when you come into the office.
Office Policies
Thank you for choosing Dr. Esser as your healthcare provider. Dr. Esser is making the following changes in her practice due to new advances in technology and multiple requests by patients. While it is always better to see you in person, Dr. Esser understands that coming into the office for an appointment may not always be an option with your busy schedule. Fees are as follows:
- Phone appointments are $60.00 per ten-minute increments and will not be prorated per minute.
- Patient portal questions that require Dr. Esser to refer to your chart or perform research in order to answer your question will be $40.00-$80.00.
- All blood draws are a $40.00 nonrefundable fee.
These fees cannot be billed to your insurance and are expected to be paid in full within 30 days from your first statement.
I understand that if I fail to pay the balance on my account this may result in a bad debt on my account which will require payment in full prior to scheduling any further appointments or could result in the account being forwarded to an outside collection agency and permanent dismissal from the practice. If this happens, I understand I will be responsible for all costs of collections, including but not limited to interest, rebilling fees, court costs, attorney fees, and collection agency costs.
We offer a cash discount of 15% for anyone paying cash (not paying via insurance) for an in-office appointment except for weight loss appointments.