New Patient Center
The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time, you will save significant time at the time of your visit.
Please print out and complete the appropriate forms and bring them with you to your first appointment.
- Please bring photo identification.
- Bring a copy of your insurance card.
- If you are being referred by another physician, please bring a copy of your referral.
- Any copies of medical testing. (e.g. ultrasound results, ER visits or testing done as a result of your referral).
Your co-payment is expected at the time of your visit. We accept cash, check, MasterCard and Visa.
We accept most insurance coverage; however, it is the responsibility of the patient to verify coverage of services. For insurance holders that require a referral, you must contact your primary physician and inform the referral clerk that you have been referred to Becky J. Smith D.O. Ob/Gyn. This should be done prior to your first visit. If you have not followed these procedures and would still like to be seen, please understand that you will be responsible for any charges incurred if the referral is denied.
Billing questions may be addressed to our business manager.
The following is a partial list of accepted insurance plans:
- Beaumont Health Insurance (UMR)
- Blue Cross Blue Shield
- Blue Care Network
- First Health/Coventry
- Great West Health Care
- HealthPlus PPO
- Health Alliance (HAP)
- Multi Plan and PHCS
- Priority Health
- Total Health Care
- Tri Care
- United Health Care