If you have any questions regarding the Patient Forms feel free to contact our main office at 732-577-1999.
Patient Registration Form
Consent for Use and Disclosure of Protected Health Information
Patient Financial Responsibility Statement
Card on File Agreement
Notice of Privacy Practices
HIPAA Consent
Office Policies
Medical Procedure Billing Form
Medical Records Release Form
Your first visit to our office will be in the form of a consultation. The physician will meet with you to discuss your gastrointestinal issues, medical and social history, and to perform a physical examination. They will then discuss with you a treatment plan and course of action.
When you contact us we verify whether we are part of your insurance plan network, or will advise you otherwise. For scheduled procedures our Billing Department’s team will contact your plan for pre-authorization, but the final decisions about whether a claim gets paid is up to your health plan. Whether you see us in-network or out of network, we will file your insurance claim forms for you. As always, check with your plan about any aspect of your coverage you’re not sure about.
Copayments are due at the time of your office visit. We will bill your insurance company for services rendered and we will balance bill you after your insurance company has processed your claim.
We send monthly statements of personal balances due. You should appeal to your insurance plan if you think the plan has underpaid for the services or if you are unexpectedly denied coverage. You should receive a notice from your plan about how they covered the claim.
We accept personal checks, MasterCard, VISA and Debit cards.
Please notify us of your preferred pharmacy. Most prescriptions will be sent electronically to your pharmacy, so if we have the correct information, refills can be efficiently processed. . Please use the Patient Portal to request a prescription refill or call the office for prescription refills during regular office hours. We cannot call in prescription refills during nights and weekends. Prescriptions will usually be sent to your pharmacy within 24 hours. Please allow time for processing and contact your pharmacy to verify that a prescription has been renewed before you proceed to the pharmacy. Please contact us if the prescription has not been renewed in a timely fashion.
Allied Digestive Health has partnered with HealthMark Group to ensure the accurate and timely completion of medical record requests.
Once you enter your email, you will receive an email with HealthMark to log in (no username or password required!). Click on the “submit request” button and follow the prompts from there. You will receive an email as soon as your records are available for download.
Do I have to remember another username and password?
Nope! HealthMark’s Request Manager uses email verification and secure links to get you your records quickly, efficiently and securely – and without yet another username and password to remember!
How long does it take to process requests?
Most record requests are processed within 8 business hours. So, one or two business days after you submit your request, your records will be delivered electronically – right to your inbox.
Is there a cost associated with obtaining my medical records?
HealthMark Group fulfills all requests for personal copies at no charge. If paper copies are requested a fee to cover delivery costs will be charged and must be paid before the records will be shipped.
Our office staff will give you detailed instructions at the time of you booking your procedure, however, here are some bullet points.
About
Our GI Care
For Your Visit
Freehold Office
222 Schanck Road,
Suite 302
Freehold, NJ 07728
P: 732- 577-1999
Mon: 9:00AM – 05:00PM
Tues: 9:00AM – 05:00PM
Wed: 9:00AM – 06:30PM
Thurs: 9:00AM – 05:00PM
Fri: 8:00AM – 3:00PM
Sat & Sun: Closed
Holmdel Office
100 Commons Way,
Suite 150
Holmdel, NJ 07733
P: 732-856-9518
Mon: 9:00AM – 4:00PM
Tues: 9:00AM – 12:00PM
Wed – Sun: Closed
Monroe Office
312 Applegarth Rd,
Suite 102
Monroe Township, NJ 08831
P: 609-662-5218
Mon – Wed: Closed
Thurs: 9:00AM – 4:00PM
Fri – Sun: Closed
Old Bridge Office
2 Hospital Plaza Rd,
Suite 340
Old Bridge, NJ 08857
P: 732-607-9300
Mon – Tues: Closed
Wed: 2:00PM – 6:00PM
Thurs – Sun: Closed
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