Home Office Policy Patient Information Biographical Information Videos  Links


Office Hours
Prescription Refills


New Patient
New Patient Questionnaire
Authorization for Release of Medical Information
Dizziness Questionnaire (if dizzy)
Office Policy Agreement

Payment for office visits is due at the time of service.  We accept personal check, MasterCard, and Visa.  We will provide you with a detailed report of the services provided at each office visit and the fee for each service.  Please keep these reports for your insurance company.  Any remaining balance from your fees will be billed to you.  Accounts must be paid within 90 days of service.  We will supply your insurance company with a full report of the services provided and other information necessary for processing your claim.  However, you are responsible for all payments.  Differences arising pertaining to a claim or delay in payment, should be resolved with your insurance carrier.  We are in network with most insurance plans..  If you have any questions regarding your bill or services provided please let us know.  We will be happy to discuss them with you.

©2012 Jackson Ear Clinic, All Rights Reserved.