New Patient Forms
If you would like to save time when you get to the office, please print off the below forms and bring them with you when you come for your first appointment. Please make sure you bring a copy of your insurance card and referral (if needed).
Medical History Information
Assignments of Rights & Benefits:
I hereby assign all rights and benefits under my contract with my insurance company to Lisa Benest, MD for the purposes of determining the details of the benefits of my policy and obtaining payment or services given.
Dr. Lisa Benest Patient Attest
While we have always kept your health information secure and confidential, a new law requires us to continue maintaining your privacy, to give you this notice and to follow the terms of this notice.
Dr. Lisa Benest Office Payment Policy
Medicare Patient Registration:
This office is required to keep your signature on file authorizing us to file claims to Medicare for you and to release information to that payor if they require it for proper consideration of a claim. Please read and sign the following statement.
To view a list of all of the insurance companies where Lisa Benest MD is a participating provider click
You will need Adobe Acrobat Reader to view these files, click here to download a free copy of this program (close the browser window which opens up when you have completed installing the program).