Randy Morton, M.D.
3209 North Fourth Street, Suite 300
Longview, Texas 75605 (903) 753-7205

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FINANCIAL POLICY

Thank you for having the confidence to choose our office for your health care needs. We want to provide the best care possible. Please read the following. It will need to be signed prior to seeing the physician.

PATIENTS WITH INSURANCE

This will be a team effort between the patient, the physician’s office staff and the insurance company. You, the patient, will need to be informed of your particular insurance requirements. If your insurance has a co-pay, that will need to be paid at the time of your visit. If you have a deductible and pay a percentage, that will need to be paid at the time of your visit. The balance will be filed with your insurance.
If a surgical procedure is required, we will be responsible for the precertification. After the insurance has paid, you will be responsible for the balance. If a payment plan is required, we will be more than happy to arrange that with you.

PATIENTS WITH NO INSURANCE

You will be responsible for payments to the physician at the time of your visit. We are willing to work out any remaining balance and provide you with a monthly payment plan in writing. We also accept credit card payments.

Signature of patient/responsible party:_____________________________
Date:_____________