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Creekside Medical Clinic, Rapid City South Dakota Creekside Medical Clinic offers exceptional and personalized outpatient medical care for all ages in an environment that values communication, compassion, and respect for our patients and staff Dr Jon Wingert, Dr Carson Phillips, Jenna Dormann PA-C, and Steve Sachs PA-C, invite you and your family to join our family at Creekside Medical Clinic
Patient Information at Creekside Medical Clinic Rapid City SD Creekside Medical Clinic offers exceptional and personalized outpatient medical care for all ages in an environment that values communication, compassion, and respect for our patients and staff Dr Jon Wingert, Dr Carson Phillips, Jenna Dormann PA-C, and Steve Sachs PA-C, invite you and your family to join our family at Creekside Medical Clinic
Insurance Bill Pay - Creekside Medical Clinic Rapid City SD Creekside Medical Clinic offers exceptional and personalized outpatient medical care for all ages in an environment that values communication, compassion, and respect for our patients and staff Dr Jon Wingert, Dr Carson Phillips, Jenna Dormann PA-C, and Steve Sachs PA-C, invite you and your family to join our family at Creekside Medical Clinic
Microsoft Word - Registration Form Rev 11-2019. docx I hereby assign all medical benefits to which I am entitled, including Medicare, private insurance, and any other health plan to Creekside Medical Clinic (CMC) I further authorize assignee to obtain my plan provisions under ERISA and to act as an authorized representative on my behalf on insurance claims This order will remain in effect until revoked by me in writing A photocopy of this
Creekside Medical Clinic, Rapid City South Dakota CREEKSIDE MEDICAL CLINIC 2822 Jackson blvd, Suite 101 Rapid City, South Dakota 57702 (605) 3+1-1208 office (605) 341-3552 www CreeksídeMedícalClínic org AUTHORIZATION TO RELEASE INFORMATION Patient's Full Legal Name Mailing Address Daytime Phone Number City State DOB (mm dd yyyy) Zip Code NO CDs PLEASE - Creekside Medical Clinic sends and accepts faxed or paper medical records only
Microsoft Word - NewRegistrationForm4. docx - Creekside Medical Clinic SECTION 3: Assignment of Benefits Release of Information Financial Responsibility I hereby assign all medical benefits to which I am entitled, including Medicare, private insurance, and any other health plan to Creekside Medical Clinic (CMC) I further authorize assignee to obtain my plan provisions under ERISA and to act as an authorized representative on my behalf on insurance claims This
Services offered at Creekside Medical Clinic Rapid City SD Creekside Medical Clinic offers exceptional and personalized outpatient medical care for all ages in an environment that values communication, compassion, and respect for our patients and staff Dr Jon Wingert, Dr Carson Phillips, Jenna Dormann PA-C, and Steve Sachs PA-C, invite you and your family to join our family at Creekside Medical Clinic
Creekside Thank you for scheduling your DOT medical exam with us at Creekside Medical Clinic
Acct Number - creeksidemedicalclinic. org goal at Creekside Medical Clinic (CMC) is to provide you with the best medical care possible Annual physicals or preventative visits give our providers a chance to address your overall physical and emotional wellness The preventative care we provide during your annual physical may include (but is not limited to) a discussion of your exercise and dietary habits, lifestyle behaviors, screening