Praveen Gupta

eMD Link

eMD Clinic

IMPORTANT INFORMATION:
We are dedicated to providing the best possible care for you. In order to achieve this goal we are in need of your assistance and completely understanding our financial policy.

INSURANCE:
We bill participating insurance companies as a courtesy to you. You are expected to pay your deductible and copayments at the time of
service. If we have not received payment from your insurance company within 45 days of the date of service, you may be expected to pay
the balance in full. You are responsible to be sure all charges are paid whether by you or by your insurance carrier. A patient without medical
insurance will be required to pay in full at the time of service.

CANCELLATIONS OF APPOINTMENTS:
If you find you are unable to keep your appointment, please notify our office 24 hours in advance. Patients who are more than 20 minutes
late will not be able to see the doctor and will have to reschedule their appointment.

TYPES OF PAYMENT:
For your convenience we accept cash, checks, and Visa, master Card, or American Express Credit Cards.

RESPONSIBILITY FOR PAYMENT:
I understand that I, personally, am financially responsible to DR. Praveen Gupta MD, AMC. for charges not covered by the assignment of
insurance benefits.PAYMENT WILL BE EXPECTED AT THE TIME OF SERVICES UNLESS YOUR INSURANCE IS VERIFIED AND YOU ARE RESPONSIBLE COPAY AND DEDUCTIBLE.