Practice Information

New Patients:

I understand that forms are never fun for anyone; however, if you are able to download this form and bring in the filled out form prior to our appointment, it allows me to spend more time understanding your immediate concerns as well as your future goals.

Patient Background Form


Prior to your first appointment, please bring in the form filled out as well as any medicines (in original medication bottles) as well as any supplements you are taking. Additionally, all clinical practice fees are due at the time of service. We accept cash, personal (non-third party) checks, Visa and Mastercard.

 

Practice:

Dr. Wise's clinical practice does contract with many, but not all, insurance companies. Please contact our office directly to find out what insurances as our office can give you the most current information. However, we do understand the financial necessities for utilizing one's health insurance.

If you choose to seek reimbursement for our services from one of the few out-of-network insurance companies, we will provide you a monthly statement of all services received. This statement is pre-formatted with all the information already entered, so that all you have to do is review the information and mail it to your health insurance. No additional information or energy is needed from you. On occasion, your insurance company may be willing to work with our office to develop a "single-case agreement" whereby they pay our usual and customary fees, but this is not always the case, and as such, please be advised that we are not always able to develop an agreement with your insurer.

 

Cancelled/Missed/Late Appointments:

Appointments scheduled and not kept, for any reason, are fully billed to you, the patient. Your insurance company will not reimburse for any portion of missed appointment(s). Cancellation notification must be given at least 24 hours before your appointment (please call the office number and leave a message). The fees for such missed appointments are the same fee as the appointment type and duration. Although we hope to be able to contact you with a reminder, we are not always able to reach you. However, when this is not possible, you are responsible for keeping the appointment and/or canceling with at least 24 hours notice. Please note the date/time of your appointment prior to leaving the office, and if you have any questions about your date/time, please contact us at 1.877.667.4366.

At Dr. Wise's sole discretion, missed appointments may be conducted via telephone at his normal non-emergency rates. However, patient/parent agrees to abide by Dr. Wise's decision regarding if telephone appointments are appropriate given the clinical circumstances.

Letters/Forms:

Letters and/or forms are often requested by patients (or their parents) to be sent to schools, employers, etc. You will be charged a letter-writing fee for this service, minimum of $25, depending on the complexity of the letter and information necessitated. This does not include school/work excuses for appointments, which are without charge.

Requests for Records:

Requests for records are received from various sources. Attention to these requests will only occur if the patient (or patient's parents) completes a signed Release of Information form. Records are copied at $0.25 per page plus postage and the total amount is billed directly to you. Please allow at least two weeks for this request to be processed.

 

Telephone Calls and Emergency/After-Hours Consultation Fee:

Telephone calls are welcome and I will respond to these as promptly as possible. There is no charge for brief calls. Calls longer than five minutes are charged directly to you, prorated at Dr. Wise's non-emergency rates, with a minimum of $100.

Of note, emergency/after-hours phone calls lasting longer than 10 minutes will be charged at the rate of $100/15 minute increment, minimum $100. In an extreme or life-threatening emergency, please call 911 or go to your nearest emergency room.

 

Any legal/forensic work is performed at a rate of $500/hour.  This includes letters for court or to attorneys, dispositions, testimonies and any other work where court proceedings are involved. Time includes the hours necessary for transportation and preparation for any legal work as well as wait time for court proceedings.

Minimum fee is $500 for one hour.

Any testimony is at a minumum of 5 hours work.  Please call for additional details.


 

Prescription Refill Rates:

Prescriptions written during clinical sessions are free of charge. Prescriptions written without an office visit will be charged $10 for regular prescriptions and $25 for controlled medications.

NOTE - PRACTICE STANDARDS REQUIRE ALL PATIENTS BE SEEN IN PERSON, AT MINIMUM, EVERY THREE MONTHS.

Thank You - I look forward to meeting you and discussing how I will help you!

Brian K. Wise, MD, MPH