Request An Appointment - Bristol

Document

First Name*

Last Name*

Phone Number*

DOB*

E-mail*

Street Address Line 1*

Street Address Line 2

City*

Zip code*

State*

Reason for appointment*

Health Insurance*

Other Please Specify

Appointment date*

Message

Instructions for your first appointment

Before your appointment, please complete the New Patient paperwork. You can do this online or print the forms and fill them out
by hand. Completing this beforehand ensures a smooth check-in process and helps us see you on time.
Bring your insurance card.
Bring a government-issued photo ID.
Have cash, check, or credit card available for any co-payments or deductibles.
Prepare a list of your current medications and dosages, including over-the-counter medications, vitamins, and supplements.
If available, bring a copy of your previous health records.

New Patient Registration Forms

Once you've scheduled your appointment, remember to fill out the new patient paperwork. You can find the forms section on our
website and download the PDF copies.

Arrival Time for your appointment

New patients are requested to arrive 15 minutes before their appointment to allow time for the check-in process. Remember to
complete your patient paperwork before arrival.

What's included in an Annual Exam

Please note that for new patients, the review of old medical records and management is not part of the annual exam. Most
insurance companies cover one wellness exam per year with certain tests to detect or prevent diseases. However, they may not
cover services unrelated to the physical exam, such as addressing new or ongoing health problems, in-office procedures, or
laboratory tests for illness or chronic conditions. Some services or discussions may not be covered, like non-scheduled
immunizations, specific pathology or Pap tests, and tests not typically needed for a patient's age or health risk. If you have
questions about what's covered by your insurance, please contact your insurance company or Human Resources Department. Any
charges not considered part of a routine physical exam will be billed separately, and any non-covered items or services will be
billed to the patient.

Prescription Policies

Please note that Bristol Primary Care LLC does not prescribe chronic benzodiazepine or pain medications.

Have you carefully reviewed all the above-mentioned points pertaining to making an appointment?

What measures do you have in place to ensure patient privacy and data security?

At our primary care clinic, patient privacy and data security are of utmost importance to us. We have implemented stringent measures to ensure the confidentiality and protection of patient information. Here are some key steps we take to safeguard patient privacy:

HIPAA Compliance: Our clinic fully complies with the Health Insurance Portability and Accountability Act (HIPAA), which sets national standards for the security and privacy of protected health information (PHI). We strictly adhere to HIPAA regulations to safeguard patient data.
Secure Electronic Medical Records (EMR): We utilize secure electronic medical record systems that are designed to protect patient information. Our EMR systems employ robust encryption and access controls to prevent unauthorized access or breaches.
Restricted Access: We have implemented strict access controls within our clinic. Only authorized personnel, such as healthcare providers and staff directly involved in patient care, have access to patient records. We regularly review and update access privileges to ensure that only those with a legitimate need can access patient information.
Staff Training and Awareness: Our healthcare professionals and staff undergo comprehensive training on HIPAA compliance and patient privacy. We educate our team members about the importance of protecting patient information, maintaining confidentiality, and following proper security protocols.
Physical Security: We have physical security measures in place to protect patient records, including restricted access to areas where paper records are stored.
Data Encryption and Backup: Patient data stored electronically is encrypted to protect it from unauthorized access. We also have regular backup processes in place to ensure the availability and integrity of patient information.
Confidentiality Agreements: All our employees and contractors are required to sign confidentiality agreements to reinforce their commitment to maintaining patient privacy and data security.

What insurance plans do you accept?

We are pleased to inform you that our clinic accepts all of the insurances listed below:

We understand the importance of having insurance coverage to access healthcare services, and we strive to provide comprehensive care to individuals with a wide range of insurance plans. Our dedicated team will work with your insurance provider to ensure a smooth billing process and maximize your insurance benefits. If you have any further questions regarding insurance coverage or billing, please feel free to reach out to our staff, who will be happy to assist you.

How can I reach your clinic for non-emergency inquiries or administrative questions?

We are here to assist you with any non-emergency inquiries or administrative questions you may have. You can reach our clinic easily through the following contact options:

Phone: Please feel free to give us a call at (860) 261-5217. Our dedicated staff will be available to address your questions and provide any necessary assistance during our regular office hours.
Email: If you prefer to communicate via email, you can reach us at bristolprimarycare@gmail.com. Our team monitors this email address regularly and will respond to your inquiries as promptly as possible.

Whether you have questions about scheduling appointments, insurance coverage, billing, or any other administrative matters, we are here to help. Please don't hesitate to contact us at your convenience. We strive to provide excellent patient service and look forward to assisting you with your inquiries.

Do you have wheel chair facility?

Yes, we do have wheelchair facilities available at our primary care clinic. We strive to provide a comfortable and accessible environment for all our patients. Our clinic is equipped with ramps and spacious areas to accommodate individuals who use wheelchairs. We understand the importance of accessibility and ensuring that everyone can receive the care they need. Please let us know if you require any assistance or have any specific accessibility requirements, and we will be more than happy to assist you.

Is there parking available at your clinic?