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Please remember to bring with you for each visit:

Copyright ¬© Kateryna Komarovskiy. All rights reserved.

New Patient Forms

Please note that these forms are available for review and acknowledgement on this website at any time. Underlined forms can be printed and filled/signed ahead of your visit.

Please remember to fast only if instructed by our office.

OUR CASH PRICE: INITIAL VISIT $150, follow-up $100. This cost includes testing of Hba1c and fasting lipid profile.

We use continuous glucose monitoring (CGM) to better treat our patients with diabetes.

‚ÄčAt this point we are not planning to use Eversense CGM in our practice but this may change in the future.

Please find below more information about it:

Patient log to take home 

About CGM:  DEXCOM     LIBRE

1. Your health insurance card, your ID, and co-payment for the visit if applicable.

2. Updated list of your medications.

3. Results of your tests that you want to discuss if they were not ordered by our office.

4. If you have diabetes please bring with you your glucose meter. If you are using continuous glucose sensor or insulin pump please bring them for every visit.

PLEASE BE AWARE THAT WE FOLLOW MEDICARE AND PRIVATE INSURANCE REQUERMENTS FOR GLUCOMETER, INSULIN PUMP/CGM USE AND WHEN REQUESTED WE WILL SUBMIT ALL NECESSARY DOCUMENTS TO INSURANCE OR SUPPLIER. IF YOU ARE INFORMED BY YOUR SUPPLIER THAT OUR OFFICE DID NOT SUBMIT NECESSARY DOCUMENTS IT WILL USUALLY MEAN THAT WE DID NOT RECIEVE ANY REQUESTS OR THAT YOUR FOLLOW-UP WAS MORE THEN 12M AGO AND OUR SUBMITTED DOCUMENTATION WAS NOT VALID TO APPROVE YOUR SUPPLIES BY INSURANCE. 

Office Policy Form

(includes assignment of benefits, financial policy, medical record policy, policy on prescription refills, prior authorizations, cancellations and no-shows, communications with office, and laboratory and other test results)