Thank you for choosing Hillside Family Medicine as your health care provider. We are committed to the successful treatment of your condition. Payment of your bill is considered part of your treatment and a clear understanding of our financial policy is important to our professional relationship.
This policy is with regard to a request for a Routine Preventative Exam (Annual Physical, Well Woman Exam, etc.). This is a specific service designed to screen for and prevent health issues. It may include a physical exam, immunization, medical tests (EKG/x-ray), counseling, and lab work depending on your individual risk factors and medical needs.
In most cases, the Routine Preventative Exam is provided by insurance under the preventative care benefits. The Affordable Care Act obligates most insurance plans to pay for this service at no cost to you.
There are important exceptions to preventative benefit coverage that are outlined in this financial agreement. This agreement will be required each year prior to receiving a Routine Preventative Exam and any associated medical tests.
If you would like to request a refund for outstanding credit balances on your account, please contact our billing department:
(907)344-0200 option 4
Hillside Family Medicine will use reasonable means to protect the privacy of your health information sent by e-mail. However, because of the risks outlined below, Hillside Family Medicine cannot guarantee that e-mail communications will be confidential. Additionally, Hillside Family Medicine will not be liable in the event that you or anyone else inappropriately uses your e-mail. Hillside Family Medicine will not be liable for improper disclosure of your health information that is not caused by Hillside Family Medicine's intentional misconduct.
At the discretion of the Hillside Family Medicine, its staff, physicians and agents (Hillside Family Medicine) and upon your agreement to the terms outlined within this consent form, you may use e-mail to communicate with Hillside Family Medicine. These e-mails may contain your personal health information. If you decide to use e-mail to communicate with Hillside Family Medicine, you should be aware of the following risks and/or your responsibilities: