New Patient Registration Forms
Please download and fill out the forms below and bring them with you to your appointment. It’s important that your forms are filled out prior to your appointment time. If you prefer to fill these out in the office, we will provide the forms for you and you will need about 15 minutes to fill them out in our waiting room prior to your scheduled appointment.
Please review the following forms. When you come in for your appointment you will be required to sign a form agreeing to our policies.
Please plan to arrive 15 minutes prior to your appointment to allow time for any paperwork.
While our office is typically on schedule, on occasion, surgical emergencies or other unanticipated situations may impact your scheduled appointment time. We appreciate your understanding. If you are traveling from far away, we always suggest calling ahead to confirm your appointment
Important insurance information for patients from Vermont, Maine, Rhode Island and Connecticut
If you have any questions, please call the phone number on the back of your insurance card and provide the NPI (see below) for our practice to see if your care with us will be covered. As a small private practice, we are unable to call your insurance provider on your behalf. The majority of our patients are from Massachusetts and New Hampshire where we are participating providers for more than 90% of our patients. If you live outside of MA or NH, it is your responsibility check with your insurance company before your appointment.
If we are not in your network, we would be happy to evaluate you for a 30 minute consultation at our self pay rates. The self pay cost for a 30 minute initial consultation is $350. Costs for surgery can be discussed AFTER the consult, not before. Surgical fees have a large range and will depend on many factors that will be discussed at this appointment.
Boston Hernia & Pilonidal Center NPI – 1407333511
Michael Reinhorn NPI – 1306837356
Nora Fullington NPI – 1306073010