Intake Process

Prior to Your First Appointment

In order to make your visit as smooth and efficient as possible, we ask that you email the following items to insurance@gillfamilymedicine.org

  • A copy of your insurance card(s)
  • Your date of birth
  • Your preferred phone number

Our staff will check your health insurance benefits and make a determination as to whether you are eligible to be a patient at Gill Family Medicine.  We will call you to discuss and set up your appointment.

Next, print the following forms from our website and fill them out prior to arriving for your appointment.

  • Demographic Sheet
  • HIPAA Privacy Form
  • Advanced Beneficiary Notice
  • Electronic Communication Permission Form
  • Patient Medical Questionnaire
  • Office Procedure Form

The links to print these forms can be found below.

When You Arrive

Please bring the following items with you to your appointment.

  • Driver’s License
  • Health Insurance Cards
  • Printed and Completed Forms mentioned above

The receptionist will verify your benefits and set your account up in our system at your first visit.

Please arrive 30 minutes prior to your appointment if you have completed all paperwork prior to arrival.

Please arrive 60 minutes prior to your appointment if you have NOT completed all paperwork prior to arrival.

Additional Information

Gill Family Medicine requires at least 24 hours notice of cancellation of your office visit. If we do not receive a notice of cancellation or if you “no show” for your appointment, a $35 cancellation fee will be charged to your account.

We send e-mails, texts and phone appointment reminders as a courtesy.

At the conclusion of your first visit with Gill Family Medicine, please be sure to ask for your login information for our Patient Portal so you can access your medical record.

Thank you and we look forward to serving your medical needs.

How We Handle Insurance & Financing

The receptionist will collect all co-pays and a $150 deposit on any “out of pocket” cost such as deductibles that have not been met. Any unused portion will be refunded to you when you check out.

Depending on what lab and/or x-ray testing is completed at your visit, you may have additional cost.

If additional testing is ordered to be completed at Gill Family Medicine at a later date such as ultrasound or nuclear stress test, a deposit of $75 or $250 respectfully, will be required prior to scheduling.

When the test is completed, the deposit will be returned to you.

If you are a self-pay patient, the receptionist will collect $150 and you will be refunded any unused portion when you check out.

Depending on what lab and/or x-ray testing is completed at your visit, you may have additional cost.

Download Forms

Below are the documents that need to be completed prior to your first visit with Gill Family Medicine.

If you are a new patient to Gill Family Medicine, please complete the Patient Demographic Sheet and the Medical History Form.

If you are a new patient to Gill Family Medicine and our Rapid Medical Weight Loss Program, please complete the consent form in addition to the Patient Demographic Sheet and the Medical History Form.

Please bring these forms with you to our office.