WE OFFER THE CONVENIENCE OF A FULL SERVICE LAB TO OUR PATIENTS
WE OFFER THE CONVENIENCE OF A FULL SERVICE LAB TO OUR PATIENTS
Forms & Policies
Forms
Please select the following necessary forms.
Policies
Refund Policy
It is the policy of Primary Care Internists of Montgomery, PC to refund all credit balances once it is acknowledged that a refund is due to the patient. If you believe that you are due a refund, please contact our office at 334-262-0342 and push 4 for our insurance/billing department.
No-Show Policy
It is the policy of Primary Care Internists of Montgomery, PC to dismiss patients of our practice if you do not show up for your scheduled appointment three times. If you are scheduled for a New Patient appointment and do not come, you will not be allowed to reschedule that appointment. We require that you cancel your appointment at least 24 hours in advance to avoid being considered as a No-Show.
Non-Descrimination Policy
Primary Care Internists of Montgomery, PC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Primary Care Internists of Montgomery, PC does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Primary Care Internists of Montgomery, PC:
• Provides free aids and services to people with disabilities to communicate effectively with us, such as:
○ Qualified sign language interpreters.
- Written information in other formats (large print, audio, accessible electronic formats, other formats)
• Provides free language services to people whose primary language is not English, such as:
○ Qualified interpreters
○ Information written in other languages
If you need these services, contact our administrator.
If you believe that Primary Care Internists of Montgomery, PC has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with our administrator 1722 Pine St, Ste 309, Montgomery, AL 36106, 334-262-0342, 334-262-0390, pcimontgomery@gmail.com. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, our administrator is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
