New Patient Forms
*Please be sure to bring a list of your current medications or your prescription bottles to your appointments.
Consent to Treat & Office Policy
Release of Medical Information FROM DFM
Release of Medical Information TO DFM
Notice of Privacy Practices
Medicare Annual Wellness Questionnaire
Insurance & Billing
BILLING POLICIES
Thank you for entrusting us with your care as we strive to serve you as personally and efficiently as possible. To meet this goal, we need your assistance. Please inform us immediately of any changes with your insurance plan or medical coverage. We will need a copy of the insurance card and effective date in order to properly bill for services.
CO-PAYMENTS
If your insurance requires a co-payment, it is due at the time of your visit. It is not our policy to bill for co-payments. For your convenience, we accept MasterCard and Visa, cash, checks and debit cards.
CANCELLATION POLICY
Your scheduled appointment is a time that is reserved just for you. If you are unable to keep your appointment, please let us know 24 hours in advance.
- $50.00 No-Show Fee for new patient appointments and physicals that are cancelled with less than 24 hour notice
- $25.00 No-Show Fee for follow-up appointments that are cancelled with less than 24 hour notice
DEDUCTIBLES
If you know you have a deductible, payment is due at the time of your visit. If you do not know your deductible, please call your insurance company.
Statements will be sent to address any balances not covered by your insurance plan, e.g. co-insurances, or other non-covered charges, and are due upon receipt.
OVERDUE PAYMENTS
If you have an overdue balance, please remit payment immediately to avoid further billing charges and collection efforts. You may not be able to schedule an office visit, except in an emergency, if you have a payment due which has not been addressed. Any balances greater than ninety (90) days in arrears will be turned over to a collection agency if not addressed. Payments can be made over the phone with a credit or debit card.
We accept most insurance plans including the following. If you do not see your plan listed, please call our office for confirmation that we accept your insurance.
Please contact our billing department with any questions at 617-431-8022.
For any non-statement billing related questions, please contact us at 617-636-3300.
| Aetna | Blue Cross/Blue Shield of Massachusetts |
| Cigna | Commonwealth Care Alliance |
| Commonwealth Indemnity | Coventry |
| Fallon Wellforce | Harvard Pilgrim |
| Health Plans Inc. | Medicare |
| Medicaid | MultiPlans, Inc |
| Tricare North Region | Tufts Health Plan |
| United Healthcare | Unicare |
Frequently Asked Questions
Need help with the cost of prescription drugs? Please use this guide to help save you and your family on medication costs. Patient Medication Costs Resources
How do I leave a message for the Physician to call me back?
If you have a medical question that our clinical staff cannot answer and does not require an office visit, we will be happy to take a telephone message for your Physician. We will ask you to provide as much information as possible, in order for the Physician to best be prepared to respond. We try to return non-urgent phone calls on the same day.
Can I schedule a same-day appointment with your office?
Each day we set aside same-day sick appointments. If we do not have a time that works with your schedule, we will make every effort to schedule you in the next day for non-emergent issues. Please be aware that you may need to schedule a same day appointment with any one of our providers based on availability.
What is your cancellation policy?
Your scheduled appointment is a time that is reserved specifically for you. If you are unable to keep your appointment, please let us know 24 hours in advance. For new patient appointments and physicals that are cancelled with less than 24 hour notice there is a $50 fee. Any follow-up appointments cancelled with less than 24 hour notice will incur a $25 fee.
What if I am not feeling well after hours or during the weekend?
For life-threatening emergencies please call 9-1-1. For all non-life threatening emergencies, please call our office before going to the Emergency Room as we may have same-day appointments or are able to assist you over the phone.
Circle Health has four Urgent Care Centers conveniently located in the Merrimack Valley. All locations provide healthcare services to children, adolescents, and adults.
Circle Health Urgent Care – Dracut
9 Loon Hill Road
Dracut, MA 01826
PHONE 978-459-2273
HOURS
Monday – Sunday
8:00am – 8:00pm
Circle Health Urgent Care – Westford
198 Littleton Road
Westford, MA 01886
PHONE 978-323-0302
HOURS
Monday – Sunday
8:00am – 8:00pm
Circle Health Urgent Care – Billerica
Treble Cove Plaza, 199 Treble Cove Road
North Billerica, MA 01862
PHONE 978-323-2850
HOURS
Monday – Sunday
8:00am – 8:00pm
Circle Health Urgent Care- Tewksbury
1574 Main Street
Tewksbury, Ma 01876
PHONE 978-323-5945
HOURS
Monday – Sunday
8:00am – 8:00pm
Lowell General Hospital conveniently offers outpatient services at many locations in and around the Greater Lowell area. Please click the link below for a full list of locations and services provided.
Patient Service Centers // Lowell General Hospital
Tufts Medicine at Lowell General – Patient Portal
***NEW PATIENT PORTAL***
READ ONLY – Old Patient Portal
Use the Health Portal above for READ ONLY access into your former patient portal.
All new requests should go through our new Patient Portal link above.