Patient Information and Forms

We recognize that your appointment day is important and it is our goal to fulfill your every expectation. Our objective is to ensure your time in the office is productive in order for the staff to focus on all healthcare concerns and needs.   We want to simplify the process of making appointments and filling out the forms that we require ahead of time by providing you with the patient information packet ahead of time. The information provided on this web page will familiarize you with the appointment-making process, as well as provide you with the forms in PDF format which you can print, fill out, and bring with you the day of your visit.   Call To Make Appointment   Please call 713-270-4545 for an appointment! You will hear an automated attendant. Please select Option 2 to speak to one of our friendly staff. We have four locations and can schedule your appointment for the location that is the most convenient for you, so please specify Houston, Sugar Land, Richmond or West Houston as your preference. Please have your insurance card in hand, as we will ask for information from the card. If there is a particular time or day of the week that is convenient for you, please let us know. We will do our best to accommodate your schedule.   Your First Visit   If at all possible, we will send you a New Patient Packet when we make your first appointment, or you can download it from this website.  We ask that you complete that Packet prior to your first appointment and bring it with you, along with your driver’s license and insurance card(s).  Please arrive 15 minutes prior to your appointment time to allow the front desk staff to copy those documents. If for ANY reason you have not completed the New Patient Packet, you must arrive 30 minutes ahead of time to complete the Packet before seeing the doctor. Appointment Day   Please bring your current insurance card and driver's license to each visit. We ask that you arrive 15 minutes prior to your appointment time so that we can update your insurance records or other changes in your personal information. We also want you to know that we verify your insurance benefits and determine your financial obligation in advance. Please come prepared to pay your applicable co-pay and/or deductible at the time of service. We will do our best to see you at your designated appointment time as we recognize your time is valuable.   New Patient Packet Please download and complete The New Patient Packet before your first visit, in order for the staff to compile all necessary information you need before seeing your physician.           New Patient Packet Form.doc

Financial Policy of Southwest Nephrology Associates, LLP Thank you for considering Southwest Nephrology Associates, LLP, to provide your renal (kidney) care.  Our main concern is that you receive the best care possible.  In order to prevent any misunderstandings and to serve you better, we ask that all patients read our financial policy.  If you choose Southwest Nephrology Associates for your renal care, we will ask you to sign this policy at your first visit.  If you have any questions or concerns about our policies, please do not hesitate to ask.   1. As a courtesy, we will file your insurance if you are a member of an insurance plan with which we are contracted. If you are not able to provide us with a valid insurance card, you will be required to pay cash for your visit. If your insurance has changed since your last visit, please inform us before your visit, so that we may verify your coverage and benefits, then bring your new card when you come for your visit. Most insurance plans require that a claim be filed within 90 days of the date of service, so if we file with your previous insurance because you have not informed us of the changes, you will be responsible for any unpaid balance resulting from the filing delays. Please remember that all charges are your responsibility, whether or not your insurance pays.   2. FIXED COPAYS WILL BE COLLECTED AT THE TIME OF YOUR VISIT. Inability to make payment at that time may require us to reschedule your visit. Deductibles, co-insurance, and non-covered services are also due at the time the service is provided. This includes Medicare deductibles and co-insurance, as it can be considered Medicare fraud to waive these amounts.   WE ACCEPT CASH, VISA, MASTERCARD, AND PERSONAL CHECKS.   3. MEDICAL RECORDS will be shared with another physician at your written request at no charge to you. If you require a copy of your chart, you will be charged $25 for this service.   4. MISSED APPOINTMENTS: If you are unable to make your appointment, we must have notice from you 24 hours in advance. If you miss two appointments without adequate notice, you will be charged a “missed appointment fee” of $25.   5. RETURNED CHECKS will incur at $30 fee. The amount of the check plus the fee must be paid within 10 days of notification by money order, cash, or credit card to prevent further action.  If a second check is returned on your account, we will no longer be able to accept personal checks as payment.