[vc_row el_class=”commonSec location-section contact-sec”][vc_column][vc_custom_heading text=”Patient Forms” font_container=”tag:h2|text_align:center”][vc_row_inner el_class=”container1100″][vc_column_inner width=”1\/3″][vc_single_image image=”15885″ alignment=”center” onclick=”custom_link” link=”https:\/\/www.tworiversurgentcare.com\/wp-content\/uploads\/2021\/03\/Document-1R.pdf”][vc_custom_heading text=”IV Hydration Form” font_container=”tag:h3|text_align:center” link=”url:https%3A%2F%2Fwww.tworiversurgentcare.com%2Fwp-content%2Fuploads%2F2021%2F03%2FDocument-1R.pdf||target:%20_blank|”][vc_column_text]<\/p>\n
If you are scheduled to come in for IV hydration. Please review and complete the document\u00a0before coming to your appointment. You can email, fax or bring the completed forms with you at your next appointment. Thank you.<\/p>\n
[\/vc_column_text][\/vc_column_inner][vc_column_inner width=”1\/3″][vc_single_image image=”15878″ alignment=”center” onclick=”custom_link” link=”https:\/\/www.tworiversurgentcare.com\/wp-content\/uploads\/2021\/03\/Document-2.pdf”][vc_custom_heading text=”Pre-Registration Form” font_container=”tag:h3|text_align:center” link=”url:https%3A%2F%2Fwww.tworiversurgentcare.com%2Fwp-content%2Fuploads%2F2021%2F03%2FDocument-2.pdf||target:%20_blank|”][vc_column_text]<\/p>\n
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.<\/p>\n
[\/vc_column_text][\/vc_column_inner][vc_column_inner width=”1\/3″][vc_single_image image=”15886″ alignment=”center” onclick=”custom_link”][vc_custom_heading text=”Two Rivers – HIPAA Policy” font_container=”tag:h3|text_align:center” link=”url:https%3A%2F%2Fwww.tworiversurgentcare.com%2Fwp-content%2Fuploads%2F2021%2F03%2FHIPAA.pdf||target:%20_blank|”][vc_custom_heading text=”HIPAA Consent Form” font_container=”tag:h3|text_align:center” link=”url:https%3A%2F%2Fwww.tworiversurgentcare.com%2Fwp-content%2Fuploads%2F2021%2F03%2FDocument-3.pdf||target:%20_blank|”][vc_column_text]<\/p>\n
Please read our HIPAA Policy, then download and sign the HIPAA Consent Form (links above).<\/p>\n
[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row full_width=”stretch_row_content_no_spaces” equal_height=”yes” disable_element=”yes” el_class=”commonSec section01 topmain-servicesec”][vc_column][vc_custom_heading text=”CONDITIONS WE TREAT” use_theme_fonts=”yes” css=”.vc_custom_1613199401044{padding-top: 40px !important;padding-left: 15px !important;}” el_class=”container1100 home-service-section”][vc_empty_space height=”18px”][vc_row_inner el_class=”container1100 home-service-section top-service-sec”][vc_column_inner el_class=”service-tex” width=”1\/3″ css=”.vc_custom_1613199573582{padding-top: 27px !important;}”][vc_column_text]<\/p>\n
[\/vc_column_text][\/vc_column_inner][vc_column_inner width=”1\/3″ css=”.vc_custom_1612947395550{padding-top: 27px !important;}”][vc_column_text]<\/p>\n
[\/vc_column_text][\/vc_column_inner][vc_column_inner width=”1\/3″ css=”.vc_custom_1613214599780{padding-top: 10px !important;}”][vc_single_image image=”15590″ img_size=”full” alignment=”center” el_class=”service-img-sec”][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row full_width=”stretch_row_content_no_spaces” el_class=”home-services-sec patient-portal” css=”.vc_custom_1613653886912{margin-top: 15px !important;margin-bottom: 15px !important;background-color: #2b7bc0 !important;}”][vc_column][vc_row_inner el_class=”container1100″][vc_column_inner][vc_column_text]<\/p>\n
[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row full_width=”stretch_row_content_no_spaces” css=”.vc_custom_1613657936957{margin-bottom: 15px !important;background-color: #edf7f6 !important;}” el_class=”insurance-payment-sec”][vc_column][vc_row_inner el_class=”container1100″][vc_column_inner][vc_custom_heading text=”PAYMENT INFORMATION” font_container=”tag:h2|text_align:center”][vc_empty_space height=”45px”][\/vc_column_inner][\/vc_row_inner][vc_row_inner el_class=”container1100″][vc_column_inner width=”1\/2″][vc_column_text]<\/p>\n
Currently we are taking Original Medicare. If you have an Advantage Medicare Plan, contact your carriers for a preferred Urgent Care Center.\u00a0 We are currently in contract talks with Freedom & Optum Medicare plans.\u00a0 Cigna, Aetna, Humana, Tricare, Blue Cross Blue Shield and United Health Care Plans are able to be seen\u00a0BUT\u00a0<\/strong>is considered\u00a0OUT-OF-NETWORK.\u00a0\u00a0<\/strong>Please contact your insurance carriers to confirm your out-of-network rates and benefits.[\/vc_column_text][\/vc_column_inner][vc_column_inner width=”1\/2″][vc_column_text]<\/p>\n We do accept credit card payments in our clinic.\u00a0 We also anticipate adding online payment processing at a future date, to pre-purchase services. Contact us for information.<\/p>\n [\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":" [vc_row el_class=”commonSec location-section contact-sec”][vc_column][vc_custom_heading text=”Patient Forms” font_container=”tag:h2|text_align:center”][vc_row_inner el_class=”container1100″][vc_column_inner width=”1\/3″][vc_single_image image=”15885″ alignment=”center” onclick=”custom_link” link=”https:\/\/www.tworiversurgentcare.com\/wp-content\/uploads\/2021\/03\/Document-1R.pdf”][vc_custom_heading text=”IV Hydration Form” font_container=”tag:h3|text_align:center” link=”url:https%3A%2F%2Fwww.tworiversurgentcare.com%2Fwp-content%2Fuploads%2F2021%2F03%2FDocument-1R.pdf||target:%20_blank|”][vc_column_text] If you are scheduled to come in for IV hydration. Please review and complete the document\u00a0before coming to your appointment. You can email, fax or bring the completed forms with you at your next appointment. Thank you….<\/p>\n","protected":false},"author":9,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"inner-newtemplate.php","meta":{"footnotes":""},"acf":[],"_links":{"self":[{"href":"https:\/\/www.tworiversurgentcare.com\/wp-json\/wp\/v2\/pages\/15862"}],"collection":[{"href":"https:\/\/www.tworiversurgentcare.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.tworiversurgentcare.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.tworiversurgentcare.com\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/www.tworiversurgentcare.com\/wp-json\/wp\/v2\/comments?post=15862"}],"version-history":[{"count":1,"href":"https:\/\/www.tworiversurgentcare.com\/wp-json\/wp\/v2\/pages\/15862\/revisions"}],"predecessor-version":[{"id":16855,"href":"https:\/\/www.tworiversurgentcare.com\/wp-json\/wp\/v2\/pages\/15862\/revisions\/16855"}],"wp:attachment":[{"href":"https:\/\/www.tworiversurgentcare.com\/wp-json\/wp\/v2\/media?parent=15862"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}CREDIT CARD PAYMENTS<\/h4>\n