Patient Forms
IV Hydration Form
If you are scheduled to come in for IV hydration. Please review and complete the document before coming to your appointment. You can email, fax or bring the completed forms with you at your next appointment. Thank you.
Pre-Registration Form
If you are scheduled to see one of our doctors for a medical complaint. Please complete the pre-registration form below. You can email, fax or bring the completed form with you at your next appointment. Thank you.
Two Rivers - HIPAA Policy
HIPAA Consent Form
Please read our HIPAA Policy, then download and sign the HIPAA Consent Form (links above).
PAYMENT INFORMATION
INSURANCE/BILLING DETAILS
Currently we are taking Original Medicare. If you have an Advantage Medicare Plan, contact your carriers for a preferred Urgent Care Center. We are currently in contract talks with Freedom & Optum Medicare plans. Cigna, Aetna, Humana, Tricare, Blue Cross Blue Shield and United Health Care Plans are able to be seen BUT is considered OUT-OF-NETWORK. Please contact your insurance carriers to confirm your out-of-network rates and benefits.
CREDIT CARD PAYMENTS
We do accept credit card payments in our clinic. We also anticipate adding online payment processing at a future date, to pre-purchase services. Contact us for information.
