Enrollment in the Center
Prospective new patients will go through a selection process, which is conditional to their enrollment in the Center.
Once the selection process is completed, and if you fit the criteria for our Center, we will then get back to you to coordinate the date and time for your appointment. If your case does not fit the criteria for our Center, you will be notified that for that reason an appointment will not be scheduled.
COVID-19 INSTRUCTIONS - PLEASE FOLLOW THESE INSTRUCTIONS BELOW TO COMPLETE AND MAIL APPROPRIATE DOCUMENTS
* EMAIL TO MS. PENDERGAST AT firstname.lastname@example.org
Please take the following steps.
• Download and fill out the New Patient Form (please return in word document -do not convert to pdf)
• Download and fill out the Patient Intake Form (please provide a copy of the insurance card - both sides)
• Download and fill out the Terms and Agreements Form
• Download and fill out the Privacy Statement Form
• Download and fill out the Assignment of Payment of Insurance Benefits and Authorization for Release of Information
• Download and complete Patient Consent Form
• Download and fill out the Release Form
• Please fill out the forms electronically and email them to Irene at IPendergast@NSPC.com
The fees are the same for patients with accepted insurance and for those making cash payments.