Practice Policies : Intake Questionnaire
Sign and return the "Acknowledgment of Polices" form after thoroughly reading our office policies. Our goal at NDFC is to provide you with the highest level of personalized care.
We are committed to helping you achieve optimal health.
It is important to read all the enclosed information carefully and complete all patient forms via your patient portal at least 7 days prior to your appointment. This will allow us to help you more efficiently and enhance the quality of your care. If your patient packet is late, it may take up to 30 minutes of your appointment time to review & enter your records. If it is an urgent visit and you are unable to finish the forms before hand, you will probably be able to complete it in the office if you arrive 20 minutes early.
NDFC is a fragrance-free office due to the chemical sensitivities of our patients and staff. Thank you!
BEING ON TIME
Dr. Croft has limited her clinic visits each day so that she can spend more time with you. We ask that you value her time as she values yours. Please arrive 15 minutes early for your appointment and keep up-to-date patient information via your patient portal before arrival. Prior to your appointment please Self Check In through your portal.
Medical records can only be released with your authorization. You are responsible for obtaining previous medical records from other physicians or health care providers. Since this is a paperless office it is ideal your past records be direct messaged or securely emailed from other providers. Alternatively, any records you receive or have that you want part of Dr. Croft's EHR, you can scan and send PDF's to be uploaded to your e-chart. This helps keep Dr. Croft's overhead down and be more efficient, thus more time for you. She will not accept any paper records. If she does she will pass them directly to you for your secure storage. If you are not sure of what information is needed please do not hesitate to ask. We are here to help. You can request one copy for transmission to another provider or yourself if transferring care for $15 for the first 30 pages and $.50 per additional page. You must sign a medical request request form prior to release of any records. Your request will be handled in a timely fashion (less than 30 days). Reference NH Senate Bill 42.
Patients referred or seeking an integrative consultation or OMM please request a referral from your PCP. This will be required prior to being seen and you are responsible for knowing your insurer's referral requirements. Please confirm an active referral on file to avoid unpaid claim you will be responsible for. Plan on an initial 60 minute medical consultation. After the exam together you and Dr. Croft will discuss any nutritional therapy, laboratory and/or diagnostic testing warranted to devise a plan of care. Test results are used to design your personal health care program as well as uncover the root causes of your medical condition. At your follow-up visit, your tests will be reviewed and you will receive a suggested treatment plan. Nutritional supplements are often recommended and Dr. Croft will help you select the highest quality products. She does have direct ordering of many nutraceutical through an online dispensary for your convenience. Since these visits are extended times if you NO SHOW / cancel within 24 hrs. you will be charged $200 to the form of payment authorized on file.
Please provide full contact information for any requested specialty referral as soon as possible. Referrals will be done timely but may take up to 2 wks to process; urgent referrals will take priority. The office WILL NOT back date any referral request for legal purposes. It is your responsibility to understand your insurance plan and policies. Thank you!
Our office visits are scheduled in 60 minute increments, and your appointment is reserved just for you! So, when you are late it affects patients following you. Thus, out of respect for others (as you'd like for yourself), if you are tardy 15 minutes or more from your scheduled time this will be treated as a "missed" appointment and you will be charged $75 and will need to reschedule--you will receive an email notification. If you completely NO SHOW for your reserved 60 minute time $200 fee will be charged to your card on file. If you call to change or cancel please understand our cancelation policy. When you do not show up for a scheduled appointment, you are taking an appointment slot that could have been used for another patient. Insurer or CMS will not cover late cancelations, missed appointments, or late arrivals because they are not covered services. After three (3) no shows or tardies it will convey a lack of commitment and Dr. Croft will consider discharging you from NDFC.
The most effective way to change appointments is sending a message via your secure patient portal.
With respect to others who may be waiting for an appointment NDFC requires a 72 hour notification to cancel before any fees apply. This will give the waiting patient time to rearrange their schedule and be sure their paperwork is complete, as well as Dr. Croft time to review their chart thoroughly. If you cancel within 48 hrs of your appointment there is a $25 fee and $50 with 24 hrs notice (by 8am each day).
For example: if a Tues 1 pm appointment -- ideally notify us before Fri. 2 pm for people are busy on the weekends
-- if notified by Sat. 8 am no charge
-- if notified by Sun. 8 am automatic $25 charge
-- if notified by Mon. 8 am automatic $50 charge
-- <24 hr notification $200 charge
Dr. Croft will discuss any unforeseen out of the ordinary circumstances that may lead to cancelations.
When you do not show up for a scheduled appointment, you are taking an appointment slot that could have been used for another patient. We will not be able to schedule further appointments for you until past balances from missed appointments are resolved. Thank you for understanding.
Being an ideal medical office, Dr. Croft aims at maximizing use of technology. Virtual on demand visits are just another benefit of being a patient. An Telehealth visit is a doctor's appointment you do LIVE face-to-face online, instead of in person. By NH Board of Medicine State law Section 329:1-d you must be an established patient before you can have an e-visit.
These visits are for simple topics and minor urgent issues:
Upper respiratory cold symptoms that you might be concerned about
Sore Throats (no fever, rash or trouble swallowing)
Early cellulitis (no red streaking, ill feelings or fever)
Sprains & Strains
Vomiting & Diarrhea
Remote monitoring of vital signs, such as blood pressure, blood glucose levels, weight, symptoms,...improves communication and optimizes outcomes. Incorporating wearable and mobile tech devices might be part of your care plan.
Discuss a diet diary with weight loss program
Refill testing supplies and medications
Manage certain chronic conditions where you already have a plan of care in place
Discuss the pros and cons of alternate treatments
Birth Control counseling
Follow up after a minor office surgery to make sure no wound infection
Insect bites (without a red streaking line, breathing issues or facial swelling--call 911)
Dr. Croft will do regular quality checks on telemedicine services to identify any potential risks and failures (such as with equipment or connectivity, and patient satisfaction. With rapid advances in technology, it’s likely that telemedicine will only become easier and more widely used. Dr. Croft is a member of the American Telemedicine Association (ATA) and Northeast Telehealth Resource Center (NETRC) whom will keep us abreast of the regulatory changes as well. For now doctors can only do e-visits in the states where they are licensed. Thus, Dr. Croft can only provide virtual visits for her NH patients. You should check your insurance carrier's telemedicine coverage policy. If it is a non-covered service you can either pay for this visit when scheduled or purchase an e-visit bundle for cost savings.
PHONE CALLS, MESSAGES
1. The preferred mode for ALL communication is via your secure patient portal.
You will be answered promptly but it may take up to 24 hrs. in some circumstances.
2. Dr. Croft's cell is (603) 275-9585 and home is (603) 938-2527 for urgent needs only.
3. When leaving a phone message, please be brief and include the following information:
a. Full name--spell your last name
b. Date of birth
b. Reason for call
c. Best time to be called back
d. Phone number(s)
e. Email address (if desired)
4. If you have a medical emergency (chest pain, breathing difficulty, acute numbness, changes in speech,...), call 911 or go directly to the nearest emergency room. DO NOT call Dr. Croft until you are in an emergency center being taken care of. This will expedite your urgent care and not delay any potentially life saving treatments. Dr. Croft admits patients under the Hospitalist Program @ Concord Hospital and has ancillary privileges at St. Joesph's Hospital in Nashua.
In order for us to provide the best possible service, we kindly ask that you not use your cell phone during appointments.
PRESCRIPTION & SUPPLEMENT REFILL REQUESTS
Please send refill requests via your patient portal. It may take up to 72 hours to process a prescription refill and 7-10 days for supplements. Please plan ahead to avoid any interruptions in your medications and supplements.
Once reviewed, your labs should be available via your patient portal. This will save you from calling us to check on results. For patients with established treatment plans, a virtual visit can be scheduled via your patient portal to discussion results and answer any questions. During these calls we will thoroughly review the laboratory findings in relation to your previous visit. If you have questions beyond that visit or in relation to other topics, we ask that you schedule an appointment or another e-visit specifically dedicated to your new issue.
CLINICAL FORMS / PAPERWORK FROM OTHER OFFICES
Dr. Croft will complete clinical forms that are part of your office visit such as routine Physical Forms for school, camp, sports or work. Records needed from NDFC can be directly messaged where ever they are needed and you will have access to these forms via your secure patient portal for your convenience. If you have forms outside of routine care during your visit, or have paperwork from other offices for us to complete, a $45 charge will be applied for the time required. Please keep your records up to date if you are working with other providers that may change your medication or treatments. Thank you!
If you have a condition that will require chronic narcotic prescriptions Dr. Croft recommends that you establish care with a pain management center. NDFC is happy to coordinate our services with such a center, and we have therapies such as herbs, counseling, acupuncture, meditation, OMT, nutrition, and massage that work well for chronic pain. Dr. Croft may be able to help you decrease or eliminate your need for pain medications using welternatives. Dr. Croft does not have any narcotic medications on the premises of NDFC.
At NDFC it is our goal to explore natural and holistic methods for treating medical problems prior to prescribing controlled substances. Dr. Croft will not prescribe controlled substances for patients on their first visit, and will only prescribe them for established patients after the third visit. If necessary, we will prescribe controlled substances only as part of a holistic treatment plan. You will need to sign a controlled substance agreement that outlines how these medications will be prescribed, understand the potential risks inherent in taking controlled drugs, as well as understand that you may only receive controlled substances from one provider or clinic. If a patient is found to be non-compliant with this agreement, Dr. Croft holds the right to refuse any future care at NDFC. She will not refill any controlled substances from other physicians under any circumstances or before complete records are received and reviewed thoroughly.
PAYMENT OPTIONS ACCEPTED & CHARGES FOR SERVICES RENDERED
We do ask you to keep an active credit card registered on your account.
The best option for you is to pay all your medical expenses is with pre-taxed monies. It is the smartest way to pay.
The authorized credit card(s) on file will be used for the annual non-covered service fee AND for all remaining balances.
Health Reimbursement Arrangement (HRA)
Health Savings Account (HSA)
Health Flexible Spending Account (FSA)
The office accepts:
checks -- Returned checks will be charged a service fee of $35.00
credit / debit cards : Sorry no American Express.
You will be responsible for any reversal or charge back credit card fees. When you schedule your initial visit, the annual non-covered service fee will be charged. This annual non-covered service fee is not prorated nor refundable. No charges will be applied to your credit card unless you miss or cancel an appointment without proper notice--detailed above or have any outstanding balances due. On the day of your scheduled appointment, all charges and co-pays/co-insurance/deductibles are due.
Unpaid balances over 30 days may be charged late fees.
CHANGES IN INSURANCE CARRIER OR POLICY CHANGES
Please keep your insurance information up to date via your patient portal. This will assist with proper billing. If you do have any policy changes and we are unaware at the time you are seen, you may be responsible for the appointment charges. You are responsible for knowing your insurance coverage, for alerting us and keeping your policy information current, and keeping your chosen PCP up to date with your insurer for correct billing. Thank you!
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