DR. BENITA CHERNYK

REGISTER AS A NEW PATIENT

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BECOME A NEW PATIENT

Complete the forms below in advance of your first appointment or arrive 20 minutes early for your first session and complete them when you arrive.   Please find the following attachments available for download:

• Registration Form and Wellness History (required)

• Privacy Policy (for you to keep)

• How To Check My Insurance Form (optional but very helpful)

• Office Directions

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FOR YOUR FIRST VISIT

• Plan to arrive early

• Call in advance if you need to cancel or change your appointment 

• Make sure you know your benefits ahead of time

• Obtain an authorization from your insurance company

• Bring you health insurance card and authorization information 

• Read the policy on privacy (attached)​

• Complete the Patient Registration and Wellness History - and sign it

• Know your co-payment and deductible responsibility in advance - The office expects co-payments and unmet deductibles to be paid at the time service is rendered.