Patient Resources

Forms and Releases

New Patient Registration Forms

Existing Patient Releases and Updates

 

APPOINTMENT POLICIES

SCHEDULING:

Please call 603.724.2297 to schedule your appointment. Early morning and late afternoon slots go first, so please plan accordingly. Our schedule is by appointment only.

We ask that you please arrive 15 minutes early to your first appointment to allow time to register. Please complete the registration paperwork prior to your appointment, and have this ready when you arrive to facilitate registration. For follow-up appointments, we ask that you arrive at least 5 minutes early to allow time to check in and arrange for payment. 

APPOINTMENT TIME:

Please understand that your scheduled appointment time is reserved just for you. We understand there may be a situation out of your control that causes you to be late for your appointment.

In such a case, our policy is as follows: If the schedule permits us to squeeze you in without major interruption to our other patients, we will be happy to do so. However, if the schedule does not allow, we will work with you to reschedule your appointment ASAP. 

CONFIRMATION:

When you call to schedule your appointment, please write the appointment date and time down somewhere where you will remember it. Please note that this time has been especially reserved for you, and no-shows or last minute cancellations are unfair to the Doctor, staff, and other potential patients. We appreciate your understanding.

For your convenience, we offer an automated email appointment reminder via “Your Health File” if you wish to leave your email address.

CANCELLATIONS:

We require at least a 24-business-hour notice to cancel or reschedule any appointment. This allows us some time to try to offer another patient the allotted time. As this is a service business, if we do not book a patient into that slot, it is lost revenue.

Please note, you will be charged for any missed appointment without 24-hour notice. Thank you for your cooperation.

 

HIPAA: Health Insurance Portability and Accountability Act of 1996

Disclosure of Protected Health Information; Public Law 104-191

 The privacy of your medical history and information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services that you receive at our office. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we will use and share your information.

HIPAA ensures the privacy and security of individual health information. The office of Dr. Brett Coapland and its direct assigns, will use your personal information solely for the purpose of obtaining appropriate medical history, diagnosis, treatment, settlement of claims, and billing for services provided by this office.

The Law requires us to:

  • Keep your medical information private.
  • Make available to you this notice regarding your rights with regards to your medical information.
  • Follow the laws with respect to HIPAA that are now in effect.

Should another physician, attorney or insurance company request information on your behalf, we will refuse such information until an authorization to release records is received from you.

As a patient, you understand, agree and comply with our privacy policy with regards to Federal Privacy Regulations. You have the right to a file a complaint and receive a copy of that complaint should you feel any of your privacy rights have been violated. Should a privacy complaint be filed, you will not be required to give up or rescind your status as a patient at this office per Federal Privacy Act Guidelines.

If at any time a patient refuses to give the necessary information as stated above, he/she may be refused as a patient.

You can view our Notice of Privacy Practices.

 

 

  • Contact Us

    91A N. State Street
    Concord, NH 03301
    P: (603) 724-2297
    F: (603) 369-3017

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