New Patient Information
We look forward to getting to know you. We desire to
have your visit to our office go as smoothly as possible.
Please plan on arriving at the office at least 15 minutes
prior to your scheduled visit time.
New patients are required to fill out a number of forms.
Because this process is time consuming, we have included
five of the necessary forms on the website so you
can download them prior to your appointment if you would like.
Please print out each of the forms below, sign them, and bring them with you to
your appointment. Having the forms completed will help
speed up the registration process considerably when you
arrive.
> New Patient Registration Form - This is a "type-in" pdf form, so you can type in your information before your print it out.
> Patient Financial Agreement
> New Patient Health Questionnaire
> New Patient Privacy Consent Agreement
> New Patient Arbitration Agreement
> Medical History Form - This form is required each time you have a physical exam.
General Office Information
We believe that having a personal relationship with our patients is vital to the practice of medicine, and we strive to employ friendly, helpful staff members to ensure the highest level of patient satisfaction. We understand that a patient’s time is valuable, and we do our best to answer all incoming calls as quickly as possible. Occasionally, when calling our office, you may reach our voice mail system. This system is in place to ensure that we can meet the needs of all our patients.
We work on a schedule to maximize our time with our patients. We will do our best to follow our schedule but we need your help. When you call in for an appointment, please tell the receptionist all the reasons for your appointment, so she can schedule the appropriate amount of time for the visit. If you have multiple medical concerns, please let us know so we can meet all of your needs when you are here.
We feel that acute problems require same day appointments, and we always have same day appointments available for you.
We realize that medical care is expensive and we try to be mindful of the costs. When we prescribe medicine, we do our best to prescribe those medications that are preferred by your insurance company. If you have a current “drug formulary” available, please bring it with you to your office visit so we can prescribe the most cost effective drugs available.
We feel that medical illnesses are best treated in the
office. Please do not ask us to diagnose or treat new
illnesses over the phone or the internet. We are
happy to discuss previously diagnosed conditions if you
are not improving, but we may request that you come back
in to the office for a follow-up examination.
Chronic conditions such as diabetes, hypertension, hypothyroidism, anxiety, depression, insomnia, chronic pain, etc. need regular follow up and the intervals for follow-up are listed under Chronic Illnesses.
Also, we are very concerned about drug dependence.
As a result, we have established strict protocols for medical conditions
requiring drugs that can lead to dependence. Please understand
our concern on this very important issue and follow the outlined intervals
for office revisits so you do not have an interruption
in needed medications.
Payment Options top
We accept Cash, Check, Money Orders, Debit Cards,
Visa, Mastercard, American Express, and Discover Cards.
Information Regarding Prior Authorization top
Insurance companies have created “prior authorization”
for certain medications to help them control costs. Most
insurance companies have forms for drugs that require
prior authorization. If no form is available, we can write
a short letter. We can only do prior authorizations if
we actually prescribe the medication. Please do not ask
us to prior authorize medications ordered by other practitioners.
Medical Records Release Policy top
We want you to know that we respect the privacy of your personal medical information and all of the information we have collected from you. We take every reasonable precaution to secure and protect your privacy.
If you need us to release your medical information, we will need
This Form printed out, completed with your release instructions, signed and then returned to our office to process. We ask that you please allow our office staff
at least 72 hours to collect and copy your records for you.
If you are transfering physicians (Ex: you are moving) there may not be a charge to copy your medical records. However, if you are obtaining the medical records for Life Insurance or for Legal reasons, there may be a $40.00 record copying fee associated.
Chronic Illness Protocols top
The following information lists Cherry Tree Family Practice's
current review protocols (revised November 14, 2010) for
the following chronic illnesses: (Pleae click on the link to jump
to the medical condition guidelines)
Diabetes
Hypertension
Hypothyroidism
Hyperthyroidism
Hyperlipidemia
Arthritis
Depression
Anxiety
Estrogen Deficiency
Diabetes
top
Diabetic targets are:
HbA1C <6.5, LDL <100, HDL > 70 (F), >35 (M),
Triglycerides <200, Total Cholesterol <180, BP <130/80,
No Smoking
Patients with diabetes:
1. Who are controlled, (meeting all of the above targets),
need to be seen at six month intervals.
2. Who have newly diagnosed diabetes or are uncontrolled,
as recommended by their provider, but at least every three
months.
3. Who have become stable after being uncontrolled, but
do not meet all the above targets, need to be seen at
three month intervals until all targets are met.
Hypertension top
Hypertension target is: BP < 135/85
Patients with hypertension:
1. Who are controlled, need to be seen at least yearly.
2. Who have newly diagnosed hypertension or are uncontrolled,
as recommended by their provider.
3. Who have become stable after being uncontrolled, need
to be seen at three months from stability, and then at
six month intervals for another year.
Hypothyroidism top
Hypothyroidism target is:
TSH as close to 1.0 as possible, free T4 in normal range.
Patients with hypothyroidism:
1. Who are controlled, need to be tested at least yearly.
2. Who have newly diagnosed hypothyroidism or are uncontrolled,
as recommended by their provider.
3. Who have become stable after being uncontrolled, need
to be tested at three months from stability, and then
at six month or twelve months as per their provider.
Hyperthyroidism top
(TSH is not usually helpful. Monitor thyroid profile.)
Patients with hyperthyroidism:
1. Who have newly diagnosed hyperthyroidism or are uncontrolled,
as recommended by their provider.
2. Who have become stable after being uncontrolled, need
to be seen and tested at three months from stability,
and then as per their provider.
Hyperlipidemia top
Lipid targets are:
Non diabetic - LDL <130, HDL > 35 (M), >45 (F),
TG < 200, TC <200
Diabetic - LDL <70, HDL > 35 (M), >45 (F), TG
< 150, TC <180
Patients with hyperlipidemia:
1. Who are controlled on medications, need to be tested
every six months. (Lipids & LFT's)
2. Who have newly diagnosed hyperlipidemia or are uncontrolled,
as recommended by their provider or every three months.
3. Who have become stable after being uncontrolled, need
to be tested at three months from stability, and then
every six months or as per their provider.
Arthritis top
Patients taking NSAIDS for arthritis, should have their
blood tested at six month intervals to be sure there is
no kidney or liver damage developing. (Do CBC & Chem
& fasting LDL if indicated)
Depression top
Those adult patients taking medication for depression:
1. Who are newly diagnosed, should be seen at four to
six weeks to have the dosage evaluated.
2. At five to six months to see if they want to try to
get off the medication.
3. At least yearly to review.
Children diagnosed with depression are unstable and need
to be seen frequently for reassessment – usually
at three month intervals. It is recommended that children
have counseling as well as see a medical provider regularly.
Anxiety top
Those patients taking medication for anxiety:
1. Who are newly diagnosed, should be seen at one to two
month intervals to assess ongoing need for medications.
2. Who take medications regularly but not daily, should
be seen at least every six to twelve months depending
on use.
3. Who take medication daily for anxiety, must be seen
at three to six month intervals by the physician who prescribes
the medication.
Estrogen Deficiency top
Those patients who take estrogen regularly should be
seen yearly for a physical examination. A patient with
an intact uterus should have a pap smear regularly as
well.
Those women who have had a hysterectomy for a reason
other than cancer,
1. But still has her ovaries - does not need a pap smear,
but does need an exam with evaluation of her heart, breasts,
a pelvic exam to evaluate her ovaries, and a rectal exam.
2. Who does not have her ovaries - does not need a pap
smear or a pelvic exam, but she does need an exam with
evaluation of their heart, breasts, and a rectal exam.
Additional Medical Information top
The following is a list of medical conditions that link to additional information we have found useful to our patients. This is given to you as information only, and should not be used in place of medical advice given by a physician. Please select the topic you would like additional information on from the alphabetical list below and download the Microsoft Word file.
Abdominal Muscle Strain
Abnormal Uterine Bleeding
Achilles Tendinitis and Rupture
Acne
Acute Bronchitis
Acute Diarrhea
Acute Pancreatitis
ADHD
Alcohol Dependence
Allergic Rhinitis
Allergies
Anemia
Angina
Animal and Human Bites
Ankle Sprain
Anorexia Nervosa
Anorexia Nervosa - More Info
Anterior Cruciate Ligament
Anxiety
Appendicitis
Arrhythmia Overview
Arthritis
Asthma
Athlete
Athlete's Foot
Bee Stings
Beta Blockers
Biceps Tendonitis
Bipolar
Bladder Infection
Blisters
Blood Lipids
Blood Pressure
Broken Ankle
Broken Collarbone
Bronchiolitis
Bulimia Nervosa
Canker Sores
Cardiomyopathy
Carotid Artery Disease
Carpal Tunnel Syndrome
Cellulitis
Chest Pain, Noncardiac
Chickenpox
Child Abuse.doc
Chronic Cough
Chronic Fatigue Syndrome
Chronic Pain
Chronic Pancreatitis
Colic
Colon Polyps
Concussion
Congestive Heart Failure
Constipation
Contact Dermatitis
Corns and Calluses
Coronary Artery Disease
Cortisone Injection
Costochondritis
Crohn's Disease
Croup and Your Child
Cuts
Deep Vein Thrombosis
Depression
Diabetes Insipidus
Diabetes Mellitus Type 1
Diabetes Mellitus Type 2
Diarrhea - Toddlers
Diverticulitis
Diverticulosis
Dizziness
Drug Abuse and Drug Addiction
Dry Skin
Dyslexia
Dyspepsia
E Coli
Eczema
Endometriosis
Enuresis
Erectile Dysfunction
Fainting
Fatigue
Fever in Children
Fibrocystic Breast Changes
Fibromyalgia
Food Poisoning
Fungal Infections of Fingernails and Toenails
Gallstones
Ganglion Cyst
Gastritis
Generalized Anxiety Disorder
Genital Warts
GERD-Reflux Esophagitis
Giardiasis.doc
Gout
Groin (Inguinal) Hernia
Groin Strain
Hair Loss and Its Causes
Hazards of Smoking
Head Injury
Headache For Teenagers
Health Maintenance Controlling Cholesterol
Heart Murmur
Heart Palpitations
Heartburn
Help for the Abused Woman
Hematuria
Hemorrhoids
High Blood Pressure
Hives
Hyperthyroidism
Hyperthyroidism
Hypothyroidism
Impetigo
Infectious Mononucleosis
Influenza
Ingrown Toenail
Insomnia
Irritable Bowel Syndrome (IBS)
Jet Lag
Jock Itch (Brief Version)
Large Bowel Obstruction
Low Back Pain
Lumbar Degenerative Disk Disease
Major Depression
Melanoma
Meniscal Tear
Menopausal Hormone Therapy
Menopause
Menstrual Cramps
Middle Ear Infection
Migraine Headache
Mononucleosis
Multiple Sclerosis
Muscle Spasms
Muscle Strains
Myocardial Infarction
Nasal Polyps
Neck Injuries
Neck Spasms
Night Terrors
Nose Injury
Nosebleed
Obesity
Obsessive Compulsive Disorder (OCD)
Onychomycosis.doc
Osteoarthritis
Osteomyelitis
Osteoporosis
Otitis Externa
Ovarian Cyst
Painful Urination
Panic Disorder
Pap Smears - Abnormal
Paranoid Personality Disorder
Paronychia
Passive Aggressive Personality Disorder
Patellar Tendonitis
Pelvic Inflammatory Disease
Peripheral Artery Disease
Peripheral Neuropathy
Pertussis
PFS Patello-Femoral Syndrome
Pharyngitis
Pink Eye
Pinworms
Plantar Fasciitis
Plantar Warts
Pleurisy
Pneumonia
Poison Ivy, Oak, and Sumac
Polymyalgia Rheumatica
Positive TB Test
Post Polio
Posterior Tibial Tendonitis
Postmenopausal Bleeding
Postpartum Depression
Premenstrual Syndrome (PMS)
Prepatellar Bursitis
Prostatitis
Psoriasis
Pulmonary Edema
Pulmonary Embolism
Pulmonary Fibrosis
Pyelonephritis
Rectal Bleeding
Reflex Sympathetic Dystrophy
Reflux Esophagitis
Restless Legs Syndrome
Rheumatoid Arthritis
Rheumatoid Foot and Ankle
Rib Injury
Ringworm
Rocky Mountain Spotted Fever
Rosacea and Its Treatment
Rotator Cuff injuries
RSV and Synagis
Sacroiliac Pain
Scabies
Schizophrenia
Sciatica
Scoliosis
Seizures
Shin Pain
Shingles
Sinus Headache
Sinusitis
Sleep Apnea
Small Bowel Obstruction
Snapping Hip Syndrome
Social Phobia
Spinal Cord Injury
Spinal Stenosis
Spondylolysis and Spondylolisthesis
Stomach Ulcer
Stress Management
Stye
Sunburn
Superficial Thrombophlebitis
Tachycardia
Taking Care of Burns
Tendonitis
Tension Headaches
Thrush
Thyroid Nodules
Tick-Bourne Diseases
Tourette's Syndrome
Transient Ischemic Attack
Traveler's Diarrhea
Trigger Finger
Unexplained Weight Loss
Upper Back Pain
Urethritis
Urinary Tract Infection in Women
Vaginal Yeast Infections
Vaginitis
Varicose Veins
Viral Meningitis
Vomiting
Warts
Weight Loss - Diets
West Nile Virus
Whooping Cough
