New Patient Information & Forms


 

This page contains information regarding our office hours, appointments, financial policies, insurance matters and other topics.

We prefer that you complete your medical information on the patient portal as opposed to printing and filling out these forms.


General Information

Welcome to the practice of Karen E. Kennedy, MD, Premier Women's Healthcare of Northwest Florida. We hope you will find our office friendly and efficient. We will do everything possible to make your visit with us comfortable. We look forward to developing a health care relationship with you. Please read the following information about our office procedures to help your visit run smoothly. We recommend you file this information at home for future reference.


Office Hours and Appointments:

Gulf Breeze Office:
 Monday through Wednesday 7:00 AM to 4:00 PM
 Thursday and Friday 7:00 AM to 12:00 noon

Navarre Office: new hours!
 Tuesday and Wedneday 7:00 AM to 4:00 PM
 Friday, 7:00 AM to 12:00 noon

Phones are off from 12:00 p.m. to 1:00 p.m. Mondays through Wednesdays.

 New patients are asked to fill out their medical history forms prior to their first appointment. (See the three patient forms at the bottom of this page.) Your attention to the details on our patient history forms assists our office in providing the best care for you.

If you are late for your appointment, we may have to reschedule. If you need to cancel an appointment, please notify our office more than 24 hours before the appointment time. This courtesy is appreciated not only by our office, but other patients as well. If a second appointment is missed without canceling more than 24 hours beforehand, you might not be able to be seen at this office. We will charge patients for not notifying us more than 24 hours before an appointment of a cancellation or change.


Financial Policy


Payment for the appointment, including co-pays, deductibles and percentages of charges are collected at the time of service. We accept checks, cash, MasterCard and Visa credit cards. Non-covered services, as identified by your insurance plan, will be considered patient's responsibility. Self-pay payment in full is expected at time of service.

Our office has a billing representative who is available during regular business hours to discuss pre-payment for surgeries should you desire this information.

Note: Pap tests and/or lab tests are routinely sent out to a local or national lab. The lab/pathology will bill separately for these services. It is important that your insurance information is current and correct for this billing to occur smoothly and to know the participating lab required by your insurance plan. The lab/pathologist will bill you directly if your insurance does not cover this service or if you pay privately (no insurance).


Insurance Policy


Thank you in advance for bringing your most up to date insurance card with you to your scheduled appointment. Copies will be made for our records.

We can bill your claims if we are a participating provider with your insurance company. However, please note...if your insurance company does not remit payment within 45 days from the date of service, your personal payment of the bill in full is expected, unless other arrangements have been made with our office. Should your insurance pay after your payment is received, you will receive a timely, full refund.

Payment in full is expected at the time services are rendered if we are not a participating provider with your insurance company.


Authorizations


If your insurance company requires an authorization from your primary care physician, please obtain this before the appointment.


After Hours


After office hours, there is an answering machine for the office where general messages may be left. Patients are asked to contact our office during office hours to reschedule an appointment. For prescription refills, a message may be left for simple refills.
Dr. Kennedy may be reached in emergencies by calling the Doctor's Directory at 850-444-5305.


Results


Tests ordered by the office will be posted on the portal by two weeks after the test is performed. Patients should check the portal for all results. If a result requires discussion, an appointment will be made.


Family Members


We are able to accommodate an extra family member attending the patient. Often the visit runs more smoothly if there are not many family members present. Please make arrangements for small children to be attended by another caregiver. Babies who can remain in their carriers are welcome.

Again, we look forward to providing you the best gynecological care for your health.




Viewing and Printing Documents and Forms


You can view and/or print our General New Patient Policy, our Patient Information form, or our History and Physical Information form if you have the Adobe Reader program. If you do not have it, you can download it using the icon at the bottom of this page.

To view a form once you have the Adobe Reader, just left-click on the appropriate button. To print a form that you are displaying, click on the 'printer' icon at the top of the Adobe Reader window.

 

Office Policy - View and/or print our Office Policy Statement from this link. This information is essentially a copy of that presented near the top of this web page.

 

Patient Information Form - This is the first form that you will either fill out in advance or you can complete it in our office prior to your first visit. This includes your name, address, insurance and other related data to ensure you receive any benefits you are entitled to.

 

Patient History Form - This second form contains a comprehensive medical history which helps us to provide you with quality medical care.

 

Patient Contact Form - This form requests a patient's contact information, including address and phone numbers. It also allows a patient to identify any individuals that are authorized to discuss billing and/or medical information.

Privacy Notice Form - This form is used for patients to confirm that they have received and read the "Notice of Privacy Practices" of the office of Karen E. Kennedy MD PA.

 

If you don't have Adobe Reader on your computer, you can download it by clicking here

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