Choose From Two Options:

1. Bill Through Insurance
2. Cash Pay ($75)

Option 1 - Bill through Insurance

  1. Please complete TeleMed REQUEST FORM and call the office (718)832-3313 to set up a virtual video appointment. Please have your insurance information available. Your Insurance status will be checked and copayment collected prior to your virtual visit. Similar to an in office visit, you are responsible for any copays, co-insurances, and deductibles, and referrals. If your health insurance carrier has changed, you must provide our office with a copy of your insurance card. ALL NEW PATIENTS to our practice must provide us with a valid photo ID, along with a front/back copy of your insurance card. If your insurance requires a referral, this must also be sent prior to your visit. Send all related insurance information to include your first and last name, date of birth, address, email and telephone number. Also if you are not the primary subscriber to your insurance you must provide us with their name, Date of Birth, and relationship to you. This information will be used for charting, billing, and sending prescriptions electronically. Any information missing or not updated will delay your appointment. The above will confirm your insurance status, it DOES NOT confirm coverage for TELEMEDICINE. In response to the Covid Pandemic, Medicare, Medicaid and most commercial insurances are covering TELEMEDICINE. *If your insurance denies the claim you will be personally responsible for the bill.
  2. Please review our Virtual Appointment Policy. I hereby acknowledge and agree that I have read and understood this message and understand my financial responsibility.
  3. Your appointment time and date will be confirmed. You can use your phone or computer for your visit and have any relevant clinical photos available.
  5. 10 minutes prior to your appointment please find a quiet location with good lighting.
  6. 5 minutes prior please click on to this to enter a virtual waiting room.
    Allow audio/video if prompted.
  7. The clinical provider will start the visit when ready

Option 2 - Private Pay $75

  • Please complete TeleMed REQUEST FORM and call the office (718)832-3313 to set up a virtual appointment. Please inform the staff that you will be paying as a private pay.
    • Payment will be collected. Provide us with you first and last name, date of birth, address, email and telephone number. This information will be used for charting and sending prescriptions electronically. Please follow steps 2-6 above.
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