Your Visit

Welcome to Falmouth Orthopaedic Center. In this section we have provided a lot of useful information and forms that will help your visit go as smoothly as possible.

New Patients | What to Bring | Returning Patients | Work-Related Injuries | Motor Vehicle Accidents
School-Related Injuries | Referrals | Payment | Cancellations

For New Patients

Falmouth Orthopaedic Center in greater Portland, Maine looks forward to having you join our host of satisfied patients. Once you have made your initial appointment, we recommend that you complete the new patient forms prior to your arrival. Doing so will help speed up the new patient registration process. You can do this by downloading the forms or completing them online.

NEW PATIENTS WITH NON-SPINE DISORDERS

Please complete the forms below and bring to your first visit:

• New Patient Registration (Download PDF file or Use interactive form)
• Medical History (Download PDF file or Use interactive form)
• Consent to Treat/Consent to Disclosure of Health Information/Assignment of Benefits/Patient Financial Responsibility (Download PDF file)
• Patient Financial Policy (Download PDF file)
• Notice of Privacy Practices (Download PDF file)

NEW PATIENTS WITH SPINE (NECK AND BACK) DISORDERS

You will need to COMPLETE AND SIGN ALL THE FORMS ABOVE, as well as the following:

• Spine History (Download PDF file)

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What to Bring

Your orthopaedic specialist will also need the following:

• Medical Records – These will usually have been sent from your doctor’s office.
• Previous X Rays, CT Scan, MRI, Bone Scan – Please hand carry a disc or films to your appointment EXCEPT for Mercy, Maine Medical Center, Intermed, and Midcoast films, which we can view on our computers
• Referral from your primary physician (if required by your insurance)
• Insurance card(s) to scan into our system
• Picture ID – To protect your personal information and prevent identity theft, we ask that all new patients present a picture ID at the first visit.

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For Returning Patients

If this is your first visit this year, we will ask you to update your insurance information and allow us to scan your insurance card(s) so that we can submit your medical claims correctly. We will also ask you to update your medical information at that time. If you have not been to our office for two or more years, we will ask you to complete new forms so that we have the most accurate information.

• Medical History Update Form

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Patients with Work-Related Injuries

Please note that all services provided to patients with injuries covered by workers’ compensation must be authorized by the workers’ compensation insurance company.If your injury is work-related, you must provide us with:

1. First report of injury (you get this from your employer)
2. Workers’ compensation insurance information, including name, address, phone number, adjustor’s name, claim number
3. Health insurance information: In the event that the workers’ compensation insurance denies the claim, we are able to submit your claim to your health insurance.

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Patients with Motor Vehicle Accident Injuries

If your injury is due to a motor vehicle accident, you must provide us with:

• Name, address, and telephone number of your insurance carrier
• Name of the insured person
• Carrier claim number

Please note that we do not accept attorney letters of protection.

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Patients with School-Related Injuries

If your injury is school-related, you must provide us with:

• Name, address and telephone number of the school's insurance carrier
• Claim number for the injury

If your claim is denied by the insurance carrier, you are responsible for payment of your bill.

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Referrals

If your insurance is an HMO/managed care plan and you are required to obtain a referral from your primary care physician, the referral must be obtained before you can be seen for an office visit. Please coordinate this with your primary care physician in advance. Appointments may be rescheduled if required referrals are not received in the office by the time of your visit.

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Payment

If your insurance plan requires you to pay a co-payment, co-insurance, and/or a deductible, it will be necessary to pay at the time of your visit. Payment will also be required for all non-covered services. For your convenience we accept cash, checks, Visa, MasterCard, and Discover. If you do not have insurance, we can arrange a payment plan for you.

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Cancellations

If you are unable to keep your appointment or are going to be delayed, please call our office. As a courtesy, we request that you provide 24 hours notice for cancellations.

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