Online: On our homepage, you can request an appointment and have someone call you for all your information. Why wait on the phone? Request an appointment online now! www.mississippisportsmedicine.com

• New Patient Packet

• Overview Form
• New Patient Form Packet
• Patient Demographics and Insurance Form
• Authority for Release of Health Information Records

• Your name
• Your date of birth
• Brief description of the reason for the appointment
• Your address
• Home and alternate (work) phone numbers
• Your primary physician or health care provider
• Your insurance information

• Driver’s License or Other Valid Government-Issued Photo Id
• Insurance card and any co-payment due for the visit
• Referral forms (if applicable)
• X-rays and any related studies (if applicable)
• Any necessary new patient or follow-up forms

If this is your first visit with us, please review the New Patient information to be better prepared for your visit.

Many people achieve more satisfaction with their health care if they can share the responsibility with their health professionals. While your physician is an expert on medical care, you are the expert on yourself. Often there can be more than one option for diagnosing or treating a condition. By acting as a partner with your doctor, you can help choose the option that best fits your values, beliefs, and lifestyle. This can make you feel more confident about carrying out the treatment you have chosen. Keeping in mind, being prepared for your visit will help you get the most out of your appointment.

• Completed Forms
• Insurance Cards and Picture I.D. (Any applicable co-pays or coinsurance will be collected at the time of service)
• Medical records including surgery notes if applicable
• X-rays, CT scans, MRIs and nerve studies
• Please bring all of the Medications you are currently taking
• A complete list of any medical problems you currently have

• • What are your main symptoms?
  • How long have you had your symptoms?
  • What were you doing when your symptoms started?
  • Have you had this problem in the past?
  • What was the diagnosis?
  • How was it treated?
  • How and when did an injury occur? How was it treated?
  • Have you had any injuries in the past to the same area? Do you have any continuing problems because of the previous injury?
  • Have you ever had surgery in that area?
  • What activities, related to sports, work, or your lifestyle, make your symptoms better or worse?
  • Do you think that activities related to your job or hobbies caused your symptoms?
  • What home treatment measures have you tried? Did they help?
  • What nonprescription medicines have you taken? Did they help?
  • Make a list to avoid forgeting any specifics.

PLEASE DO NOT MAIL YOUR PAPERWORK, BRING IT ALL WITH YOU TO YOUR APPOINTMENT.

• Please arrive for your scheduled appointment on time. We recommend that new patients arrive 20 minutes early to fill out any necessary paper work. Patients who arrive more than 15 minutes after their scheduled time may need be rescheduled.

• All of our physicians and therapist at Mississippi Sports Medicine believe strongly in the importance of every patient keeping their appointments. When patients fail to keep their scheduled appointments they miss out on sometimes crucial medical information regarding their recovery. Unfortunately, our clinic has experienced an increasing number of No-Show appointments. Therefore, we have had to institute a policy of billing patients for their missed appointments.

• Please be advised that we require no less than a 24 hours notice whenever an office/physical therapy appointment is cancelled, and 48 hours for all surgery appointments. If you have an appointment on a Monday before 12:00pm, you must call before 12:00pm the Friday prior to your scheduled appointment or you will be billed a No-Show fee. Insurance plans are not responsible for No-Show Fee’s: it is the responsibility of the patient to pay the bill upon receipt. If you need to cancel an appointment and it is after hours or during the weekend, you may leave a message with our answering service. We recommend that you make a note of the name of the service operator/receptionist whenever you call to cancel or reschedule an appointment.

Fee Schedule for No Shows & Cancellations

• Physician Office Visit $30.00 must be cancelled within 24hrs
• Physical Therapy Visit $30.00 must be cancelled within 24hrs
• Surgery $300.00 must be cancelled within 48 hrs

** If a patient is a no show 3 times, they may be discharged from our practice **

• Blue Cross
• Mississippi Health Partners
• United Healthcare
• Cigna
• Aetna
• Tricare
• Humana
• Medicare
• Workers’ Compensation (excluding the Department of Labor

Even though your insurance may not be shown on the list, you may call (601) 354-4488 or (800) 624-9168 to see if we now accept it.