All patients must complete a New Patient Questionnaire prior to their initial visit. This provides Dr. Burkhart with the information necessary to understand your condition and how she can best help you. The new patient questionnaire will be sent electronically at the time of scheduling.
Forms are now submitted electronically. Log-in information for the intake form will be sent at the time of scheduling. For people who prefer to send in an actual copy of the form, it is included below.
- *Please submit your health questionnaire electronically at least one week ahead of your appointment date. If you choose to complete a paper copy, please contact her assistant-you may mail it or drop it by the office at any time. There is a locked drop box at the door.
- *If we have not received your questionnaire prior to your appointment we will ask that you reschedule your appointment.
- *If you are attempting to get an appointment sooner than is currently available, please complete the questionnaire as soon as possible. Priority for cancellation spots is given to patients with a completed questionnaire.
- Due to health privacy rules, Dr. Burkhart is unable to receive questionnaires via email.
- The initial consultation fee includes the 2-hour appt. and the time Dr. Burkhart spends on pre-appointment research and preparation.
- Since many of her patients have complicated medical histories, Dr. Burkhart likes to review all cases ahead of time. If questionnaires are not received before the initial appointment, we will ask that you reschedule the appointment.
- The initial health questionnaire is very comprehensive. Submitting it ahead of your appointment date allows more time to discuss your unique situation with Dr. Burkhart during the actual visit. The questionnaire is now electronic. You will receive a link at the time of scheduling. If you have difficulty with the electronic version or do not have a computer, please contact her assistant.
- She does not participate with any insurance plans and does not bill insurance directly but will gladly provide you with a completed form to send to your insurance company for possible reimbursement.
- Some insurance companies will provide partial reimbursement for the consultation and full coverage for any laboratory testing. Please check with your insurance provider to verify the details.
- Payment is due at the time of service.
- Please call the office at (707) 927-5622 for the fee schedule.
Please remember this is a consulting service. You need to continue your treatment with a primary care physician for routine care and emergencies.
