Appointments and Forms
We schedule patients by appointment. Please have your insurance card handy when you schedule your appointment and plan to arrive at least 15 minutes early for your first visit. Remember to bring your insurance card and driver's license or other proof of ID with you! We request a 24 hour notice to cancel an appointment.
For New Patients ~
New patient forms are located on the patient portal. To access the portal, enter the patient ID number you were given when you made your first appointment. Please fill out, print, and bring the forms with you to your first appointment. Below, you will find additional forms that you may find useful:
For Established Patients ~
If you have not previously completed the Privacy Practices, Authorization
of Medical Release or the Financial Policy Forms, or if any of your
Demographics information (last name, insurance company,
address,phone number, employer) has changed, please bring these
completed forms with you to your next appointment.
We accept most major medical, PPO, HMO and Medicare insurance plans. We know that insurance rules can be confusing, and while ultimately it is the patient's responsibility to verify benefits and attain any required pre-certification or pre-authorization from her insurance carrier, our staff makes every effort to assist you in that endeavor. We are not Medicaid providers.
Pre-payment of Patient Portion of Obstetrical Care:
Mt Vernon OB/GYN will contact your insurance company to verify
your benefits for obstetrical care and delivery. Full payment of the
patient responsible portion of your care is required by the 24th
week of pregnancy. Please remember, the insurance company will
only estimate the amount you may owe. The verification of
benefits is not a guarantee of payment. Any costs not paid by
your insurance company will become the patient's responsibility
to pay. Please call your insurance company if you have any
questions. The fees prepaid do not include fees for an
unplanned C-section, multiple births, labs, ultrasounds,
hospital care, or other fees generated outside of our office.
Payment & Billing:
- Payment is due at the time of service, unless other arrangements were previously made. We discuss fees and arrange convenient payment schedules for obstetrical care and gynecologic surgery with you at your initial visit.
- If you have insurance, we will gladly process your forms.
- We request that you pay your estimated portion when services are rendered, this includes deductibles and co-insurance. We accept most major credit/debit cards.
- The charge to copy medical records is $25.00 and up, depending on the number of pages. We can mail your records, or scan and send via encrypted e-mail to your insurance company, hospital, home or another doctor's office. The records are sent after the applicable fee is paid.
Emergencies and Call Schedule:
- We make every effort to see emergencies in our office immediately, and we keep time slots open in the schedule to accommodate them. If you are experiencing a life-threatenting emergency, call 911.
- Dr. Blank shares week-night call with one Board Certified OB/GYN, and weekend call with four Board-Certified OB/GYNs. To reach the on-call doctor after office hours, call our answering service at 770-997-5172.