Patient Information

Save time during your visit by filling out patient forms prior to coming. Forms include patient registration, insurance info, billing procedures and more.

Medical History Form

HIPAA Release Form

Patient Demographic Form

Medical Release Form

Insurance: We accept most forms of insurance, including Aetna, Blue Cross Blue Shield, Cigna, United Healthcare, Medicare and Medicaid.  North Main Medical is committed to providing quality and cost-effective healthcare to our patients. It is essential that you understand what services are covered by your insurance plan and obtain all authorizations prior to your appointment. Your doctor may recommend services he/she feels are beneficial but may not be covered by insurance.

It is your responsibility to understand the limit and restrictions affecting coverage for these services. It is your responsibility to provide us with your most current billing information. Insurance reimbursement is a contract between you and your insurance company. As a courtesy to you we file all claims for you.

We will require a current copy of your insurance card in order to do this and will need to be informed of all changes in insurance status. You will be responsible for all co-pays, deductibles, co-insurance amounts along with the entire amount of any non-covered services. Payment for services is expected at the time of service.

Please bring your government-issued photo ID and your insurance card with you when you come to the clinic. When you get here, we’ll need to see both and confirm your birth date.

Learn how we protect patient privacy at North Main Medical, LLC Urgent Care & Family Medicine.

Privacy Policy