Patient Info/Forms

 

Home Literature

Click Here to Go To Our: Renew My Image Medical Spa

 

Home
Forms
Testimonials
Gifts
Search




 

 

Welcome to the Renew Total Body Wellness Center

We are glad you are here - we offer two options to establish care:

  1. Establish or Transfer Care - Establishing care or moving care from your present doctor to Renew - our office will provide your healthcare from here forward.
  2. Consultation - Keeping your present doctor, you are just coming for evaluation and possibly treatment of Health, Hormonal, or Skin related issues.

To start your healthcare with renew, please download the necessary forms by clicking on this FORMS link or on the left navigation bar.

We are committed to make this a convenient, comfortable place for you to obtain your healthcare and cosmetic services.

We provide care for most medical conditions and for most ages from infants through older adults. To preview our range of healthcare services click HERE

Our office provides care for you or for your entire family in an outpatient, or office only, setting. Our focus on outpatient care allows us to provide timely and personalized care for you in the comfort of our office.


Our Patient Procedures: (Click a link Below)


New Patient Procedures

REGISTRATION

When you register as a new patient, we will ask you to complete registration forms prior to scheduling your first appointment. For your convenience you may 1) download those from this Office Forms button or left above, or 2) you may stop by the office and pick them up. Please complete these forms and then fax them to us or bring them with you to the office so we may schedule your appointment.

When you arrive at the office, please check in with our front office staff. As a new patient, you will be asked to complete several forms to establish your medical record if you did not already complete them prior to your visit.

In order to complete your forms accurately, please bring along:

  • Insurance Information
    • Your insurance card(s).
    • The address and phone number of your insurance company.
  • Health Information
    • Past hospitalizations and surgeries.
    • Family medical history.
    • Please bring along all medications and over the counter pills or supplements you are currently taking.
    • A record of all immunizations.

Generally we DO NOT require your old medical records except for the most recent lab work or testing such as mammograms. If we need to obtain any other past medical history we will ask you to complete a transfer form after your first visit.


OFFICE HOURS / EMERGENCIES

Office Hours:

  Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Morning closed 8:00-12:00 8:00-12:00 8:00-12:00 8:00-12:00 8:00- 12:00 closed
Noon closed closed closed closed closed closed closed
Afternoon closed 1:00-5:30 1:00-5:30 1:00-5:30 1:00-5:30 closed closed

Click Here to go to the Appointment Page

Emergency Contact:

If you have a medical emergency please go to the nearest emergency room or dial 911. 

Second, if this is a question or problem that can wait for the next normal business day, please call back between 7 and twelve in the morning or 1 and 6 in the afternoon and we will be glad to assist you.

Finally, if you feel that your question or problem is urgent and canít wait until the next business day I am on call for the office. Please dial our call phone at 217-897-1548 for assistance.

APPOINTMENTS

We operate by appointment only.

Call us when you want to be seen - We use Open Access Scheduling - this means that nobody will wait longer than 3 days for an appointment! How do we do this? We do not schedule recheck appointments for weeks or months in advance thus opening the schedule with appointment times to serve you and your family in a prompt and timely manner!

  • If you have an acute problem - sore throat, ear pain, etc., we will see you within 24 hours, and often the day you call in.
  • If you have a non-acute problem - annual physical or pap exam, follow-up on diabetes, hypertension, etc., we will schedule you as soon as possible.

We will make return appointments for follow-up visits and procedures that take extra time at the time you check out to make sure you have a return date for appropriate continuity care.

When you call our receptionist will ask about the nature of your problem in order to allow enough time for your appointment. In some cases, you may be asked to speak with my nurse who will determine how we can best help you.

If you are unable to keep your appointment, please call the office at least 24 hours in advance of your scheduled appointment to cancel so that we may accommodate another patient's needs.

We have a "NO SHOW" policy as we can't provide you with the quality care you deserve if you or other patients schedule and miss your appointment - this is time that could have been extended to another patient. We charge $50 for not cancelling a routine appointment 24 hours prior to the appointment, and $100 or more for not cancelling a lengthy consultation or procedure appointment.

After repeated failures to keep or cancel an appointment, you or your entire family may be asked to choose another physician that you feel comfortable keeping your appointments with. This is vital for your health - and for our ability to provide the best care for all our patients!


SHOULD YOUR CARE REQUIRE HOSPITALIZATION:

Decatur Memorial Hospital - I no longer maintain hospital privileges at DMH, therefore I do NOT personally provide in-hospital care. I rely on the DMH Hospitalist doctors, who are internal medicine physicians, to provide care for my adult patients. They are present in the hospital all day rather than visiting you once a day in the morning as I normally would on rounds. They are able to visit you several times a day as necessary and they can make immediate changes in your care as your condition changes. This improves care in the hospital and generally allows you to recover more quickly and return home sooner! The pediatric hospitalist provides care for my newborns, infants, and children at DMH. I have daily communication and updates from your in-hospital physician on your care and progress. I will always know how you are doing.

St. Mary's Hospital - I do not maintain hospital privileges at St. Mary's hospital. If you are hospitalized your care will again be provided by the hospitalist physicians.


HEALTHCARE SERVICES WE PROVIDE

We offer a wide variety of medical services - click on these links to explore all of the care we provide:

We also offer the convenience of on site blood draws for labwork - your specimen(s) will be sent to our reference laboratory and billed through our office or to DMH and billed by the hospital.

We no longer offer in office X-ray services and will give you an order slip to have those completed at a location of your choosing.


CONFIDENTIALITY

Your care is strictly private. No information regarding your care will be given without your permission, except when required by law. You will be asked to sign a privacy form, called a HIPAA form during your initial visit. If you have any concern about your privacy, please talk to our receptionist.


 

MEDICATION REFILLS

We request a 24-hour notice for medication refills to be granted. Please contact your pharmacy with your refill request and then they will contact us for authorization.

Authorization for routine refills is not available during non-office hours.

NOTE: Antibiotics and Narcotics will NEVER be prescribed after hours or on call without being seen in the Emergency Room!


BILLING AND INSURANCE

  • Payment is expected at the time that service is provided.

    • Cash payment discounts are only valid on the day of service - if not paid on that day, charges revert to full value.

    • Any co-payment(s) required to be paid by your insurance are expected at the time of service - we will collect this at the time you check in. If you ask us to bill you for a co-payment we will add a $20.00 convenience fee to your bill for that service unless prior arrangements have been made.

    • Even though you may have insurance coverage, you are responsible for any charges incurred and for paying your bill. Payments may be made at our office, through our website by clicking PAY ONLINE, or by mail. We accept cash, checks, and multiple credit cards for your convenience.

  • Any overpayments made on your account will be refunded. Please keep all receipts and statements for your income tax records.

  • Patients with insurance coverage will need to complete registration paperwork. This includes the following information:

    • Your insurance effective dates, co-payment amount(s), and any deductible amount PRIOR to scheduling your first visit.

    • We also require that you bring by or send us a front and back photocopy of your insurance card(s) PRIOR to scheduling the first visit of each family member.

  • We will bill for Medicare, HMO and other insurance coverage. It is your responsibility to know what your insurance deductible and any co-payments are. We will gladly assist you with any insurance claim problems.

  • We require a personal payment each month on any outstanding account balance. If you are having problems meeting your payments, please talk to Peggy and we can make a mutually agreeable payment plan

We will always try to work with you to make financial arrangements to pay past due accounts. However, in cases where an account remains delinquent for more than 90 days, despite our best efforts, we will be forced to turn your account to our collection agency for processing. Once your account is turned to collection all medical services to the patient and their immediate family will be terminated. Please don't allow this to happen by ignoring your situation - talk to us - we're here to help you.

LOCATION AND PARKING

Our office is located near the intersection of Baltimore and Route 36 at 3798 E. Fulton Avenue. Click Here for directions and a picture. Convenient parking is out front.