Please use the Patient Portal icon below and complete the requested information to register through the portal. Our physicians and staff will be able to communicate lab results, appointment reminders, and health maintenance reminders to you via your secure login to the portal.
Our patient portal will allow you to:
- Complete new patient registration forms
- Update demographic information
- Update your medical record
- Submit Appointment Requests
- Submit Prescription Refill Requests
- View Lab & Test Results
- Submit a question to the Nursing Staff
- Submit a question to the Billing Staff
3533 Southern Blvd.,
Kettering, OH 45429
758 W. Central Ave.
Springboro, OH 45066
These forms are rendered in PDF format.
To use: print out a form, complete it and return to our office.
NEW PATIENT INSTRUCTIONS
If it's your first visit to Obstetrics & Gynecology South, we strongly encourage you to log onto the patient portal and complete the new patient forms in advance of your appointment. This will allow us to streamline your registration process. If you are unable to access the portal, please complete the forms available in the left-hand column of this page and bring them with you to your appointment.
If you've received gynecologic care elsewhere in the past, please ask them to forward a copy of your prior medical records to our office so that we have all your medical information.
On your first visit, we'll review your medical history thoroughly with you, talk about your current health needs, and offer you treatment options if necessary. If at any time, you have questions, please ask us. Our staff is happy to assist you!
We do ask that you arrive 15 minutes prior to your first visit so that we may better serve you. It is important that you bring your current insurance information, your driver's license, and your co-payment with you to your appointment.
We are dedicated to providing the highest quality health care at a reasonable cost. Therefore, in order to streamline our administrative process and keep our fees down, we ask that you pay for your office services at the time they are rendered. Payment may be made by cash, check, money order, or credit card.
Should you experience financial problems that result in delayed payment of your account, please contact our billing office. We will work with you to arrive at an acceptable plan which will enable you to take care of your obligation.
If you are a member of a health maintenance organization (HMO) or preferred provider organization (PPO), please inform us at the time you schedule your first appointment. If we are a participating provider, we will submit the claims for you. We also accept assignment from Medicare, and will file these claims for you. Medicare patients with a secondary coverage must send our office a copy of the Explanation of Medicare Benefits (EOMB) form in order for us to file the claim.
Any deductibles or co-payments are the patient's responsibility, and will be due at the time of service. For patients covered by other forms of insurance, we will provide a "superbill" which contains all the information needed for us to file your claim. However, our professional services are rendered and charged to the patient and not to the insurance company. Insured patients are therefore expected to take care of their fees for services rendered, and to accept responsibility for negotiating with their insurance for settlement on disputed claims.
Many insurance companies require a second opinion prior to surgical procedures. Most also require pre-certification, or notification prior to hospital admission for inpatient or outpatient treatment. If your insurance requires either, you must notify us prior to your admission. If you are unsure of your policy requirements, please contact your insurance company.