Practice Policies & Patient Registration (Must hit submit at bottom to be registered)
Cancellation Policy: Appointments must be canceled at least 24 hours before the appointment. Otherwise, you will be charged at the full rate for the cancelled/missed appointment. Both telephone and email are an acceptable form of communication to cancel an appointment.
Fees: Dr. Werely’s services are billed on a new patient and follow up rate. New patient visits are scheduled for 1 hour and are $900 follow up visits are scheduled for 30 minutes and are $400.
Insurance: Dr. Werely does NOT participate with insurance, including Medicare & Medicaid. An itemized statement can be provided that can be submitted for reimbursement pending out-of-network benefits.
Payment: All outpatient visits must be paid at the time of the visit. Payment can be made by cash, check or credit card. Patients must have a valid credit card on file that will be billed in full for the cost of the visit if an appointment is missed or not canceled with at least 24 hour notice.
HIPAA: THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. We are required by law to maintain the privacy of your medical information. We must provide you with a copy of this notice. We must follow the term of this notice. If the notice is changed in any material way, a revised notice will be available. We will use your medical information for treatment. We will use your medical information for payment. For example, we may need to give your insurance plan information about your diagnosis, treatment and supplies used. We may contact you at any phone number, e-mail or address you have provided to us to remind you of your appointment, other health care matters and/or obtain payment for our services.
We may disclose your medical information to your family members or others you have assigned or who are involved in your care or payment for that care. You must notify Jennifer Werely, MD in writing if you do not want us to communicate with those above in any of the ways listed above. We may use your medical information for any uses that are required or permitted by law. Other uses and disclosures will be made only with your written authorization. You may cancel an authorization at any time by notifying us in writing.
You have these following rights: Right to privacy notice; Right to request communications; Right to inspect and copy your medical information; Right to request an amendment to your medical information; Right to an accounting of disclosures to Human Services at 877.696.6775.
Emails: Email is not a confidential means of communication and E-mail is NOT appropriate communication for urgent/emergent matters.
In the event of an emergency, please call 911 and go to your nearest Emergency Room.
**COMPLETE PATIENT REGISTRATION BELOW